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首页> 美国卫生研究院文献>Journal of the Royal Society Interface >Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population
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Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population

机译：基于效果模型法的方法与传统临床实践指南的最佳治疗决策比较：在法国人群中他汀类药物治疗中的应用

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Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES—in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective–Threshold–Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr−1). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs.
机译：医疗保健当局对如何花费有限的预算进行干预以确保最佳的成本效益比做出艰难的决定。我们用法语提出了一种新的治疗决策方法，即OMES-法：ObjectifthérapeutiqueModèleEffet Seuil（英语：治疗目标－阈值－效应模型； TOTEM）。这种方法考虑了临床试验的结果，并根据患者的治疗决策特点对其进行了调整。我们将OMES与法国临床实践指南（CPG）进行比较，以计算机生成的现实虚拟人群（代表法国成年人口）中的他汀类治疗血脂异常的情况，从避免的全因死亡人数（避免的事件数量） ：NAEs）和个人绝对利益。总预算固定为法国社会保障机构对他汀类药物的年度报销额。对于CPG，NAE为292，年成本为12254万欧元，而OMES为443。对于固定的NAE，OMES降低了50％的成本（6053万欧元yr -1 ）。结果表明，当应用于相同人群时，OMES至少与标准CPG一样好，甚至更好。因此，OMES方法是一种实用且有用的替代方法，它将有助于克服基于CPG的治疗决策制定的局限性。

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