Abstract:
BACKGROUND:3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy has proven efficacy in reducing the rate of coronary and cerebrovascular events in patients 75 years of age or younger with a history of myocardial infarction. However, in patients older than 75 years of age, the efficacy and potential cost-effectiveness of statins are unknown. OBJECTIVE:To estimate the incremental cost-effectiveness of statin therapy compared with usual care in patients 75 to 84 years of age with previous myocardial infarction. DESIGN:Cost-effectiveness analysis. DATA SOURCES:Published data from cohort studies. TARGET POPULATION:Patients 75 to 84 years of age with a history of myocardial infarction. TIME HORIZON:Lifetime. PERSPECTIVE:Societal. INTERVENTION:Statin therapy. OUTCOME MEASURES:Life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS:The incremental cost-effectiveness of statin therapy compared with usual care in patients 75 to 84 years of age with previous myocardial infarction was $18800 per quality-adjusted life-year (QALY). RESULTS OF SENSITIVITY ANALYSIS:On the basis of a probabilistic sensitivity analysis, there is a 75% chance that statin therapy costs less than $39800 per QALY compared with usual care. If the cost of statin therapy and efficacy of statin therapy at reducing myocardial infarction were set to their most favorable values, statin therapy cost $5400 per QALY; if cost and efficacy were set to their least favorable values, statin therapy cost $97800 per QALY. CONCLUSIONS:The cost-effectiveness ratios of statin therapy in older patients with previous myocardial infarction are reasonable under a wide variety of assumptions about drug efficacy, drug cost, and rates of cardiac and cerebrovascular events. Pending results of randomized, controlled trials of secondary prevention in patients in this age group, statin therapy seems to be as cost-effective as many routinely accepted medical interventions in this setting.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Ganz DA,Kuntz KM,Jacobson GA,Avorn Jdoi
10.7326/0003-4819-132-10-200005160-00003subject
Has Abstractpub_date
2000-05-16 00:00:00pages
780-7issue
10eissn
0003-4819issn
1539-3704pii
200005160-00003journal_volume
132pub_type
杂志文章abstract::Subjects (109) with symptomatic Paget's disease of bone were treated with 5, 10, or 20 mg of sodium etidronate (EHDP)/kg body weight - day for 6 to 24 months. Significant decreases in serum alkaline phosphatase and urinary hydroxyproline were noted after 6 months of therapy; no significant further improvement resulted...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-87-6-656
更新日期:1977-12-01 00:00:00
abstract:BACKGROUND:Depressive disorders are persistent, recurring illnesses that cause great suffering for patients and their families. PURPOSE:To evaluate the benefits and adverse effects of newer pharmacotherapies and herbal treatments for depressive disorders in adults and adolescents. DATA SOURCES:English-language and no...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-132-9-200005020-00011
更新日期:2000-05-02 00:00:00
abstract:BACKGROUND:Several studies show an inverse association between self-reported physical activity and type 2 diabetes. It is not known whether physical activity or cardiorespiratory fitness is associated with the onset of objectively determined impaired fasting glucose and type 2 diabetes. OBJECTIVE:To determine whether ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1999-01-19 00:00:00
abstract::Ambulatory education has become an essential part of all internal medicine residencies. To develop excellent ambulatory education programs, we must thoroughly understand the opportunities available in such a setting, and the leaders in internal medicine must be willing to experiment with nontraditional locations and r...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-12-1076
更新日期:1992-06-15 00:00:00
abstract::Enlargement of the pituitary gland associated with primary hypothyroidism was observed in two patients. Serum thyroid-stimulating hormone (TSH) concentration and the TSH response to thyrotropin-releasing hormone were increased in both. Other pituitary function tests were subnormal in both patients, suggesting that a t...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-85-2-195
更新日期:1976-08-01 00:00:00
abstract::We evaluated bone disease in eight white men between the ages of 49 and 61 years who had been abusing alcohol for at least 10 years. The mean density of vertebral cancellous bone was 58% of normal, whereas the mean density of appendicular cortical bone was 90% of normal. Marked reduction in active bone resorption and ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-103-1-42
更新日期:1985-07-01 00:00:00
abstract::Increased adrenocorticotropic hormone (ACTH) levels after bilateral adrenalectomy could be secondary to a pituitary tumor, under replacement with cortisol, or an abnormality in the hypothalamic-pituitary-adrenal feedback loop. To distinguish between these possibilities, ACTH levels were measured before and after corti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-3-277
更新日期:1982-03-01 00:00:00
abstract:BACKGROUND:Pretreatment antimicrobial resistance has an important impact on the efficacy of many Helicobacter pylori treatment regimens. OBJECTIVE:To estimate the prevalence of H. pylori resistance to antimicrobials in the United States, to characterize risk factors associated with H. pylori antimicrobial resistance, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
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更新日期:2002-01-01 00:00:00
abstract::Deaths and injuries from firearms are significant public health problems, and clinicians are in a unique position to identify risk among their patients and discuss the importance of safe firearm practices. Although clinicians may be ill-prepared to engage in such discussions, an adequate body of evidence is available ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:2019-06-04 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-1-93
更新日期:1987-07-01 00:00:00
abstract::For years patients hospitalized with viral hepatitis have been placed in two categories of isolation--enteric precautions and blood precautions. This strategy was based on the inability to differentiate between hepatitis A and B and on the assumption that feces and blood from patients with either type might be infecti...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-6-872
更新日期:1979-12-01 00:00:00
abstract:BACKGROUND:Severe aplastic anemia is a life-threatening bone marrow failure disorder. High-dose cyclophosphamide therapy followed by allogeneic bone marrow transplantation cures the disease. However, it requires a suitable donor and carries the risk for graft-versus-host disease. A small pilot study demonstrated that h...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究
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更新日期:2001-10-02 00:00:00
abstract:BACKGROUND:Medical students may be at high risk for occupational exposures to blood. OBJECTIVE:To measure the frequency of medical students' exposure to infectious body substances, to identify factors that affect the probability of such exposure, and to suggest targets for the prevention of such exposure. DESIGN:Revi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1999-01-05 00:00:00
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更新日期:2003-02-04 00:00:00
abstract::This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for family and intimate partner violence, based on the USPSTF's examination of evidence specific to family and intimate partner violence, and updates the 1996 recommendations on this topic. In 1996, the USPSTF found...
journal_title:Annals of internal medicine
pub_type: 指南,杂志文章,实务指引
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更新日期:2004-03-02 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-91-3-441
更新日期:1979-09-01 00:00:00
abstract:OBJECTIVE:To determine the causes of persistent dizziness in outpatients. DESIGN:Consecutive adult outpatients presenting with a chief complaint of dizziness. SETTING:Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital. PATIENTS:Of 185 patients presenting during the 10-mon...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-117-11-898
更新日期:1992-12-01 00:00:00
abstract:OBJECTIVE:To define the temporal characteristics of cocaine-induced coronary vasoconstriction in humans and to assess the relation between cocaine-induced coronary vasoconstriction and the blood concentration of cocaine and its main metabolites. DESIGN:Randomized, double-blind, controlled clinical trial. SETTING:Card...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-116-7-556
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century. OBJECTIVE:To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies. DESIGN:Compartmental epidemic model in conjunction with a Markov mod...
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abstract::A retrospective analysis of the course of systemic lupus erythematosus in pregnant patients hospitalized at UCLA during a 15-year period provided important prognostic information. Women with systemic lupus erythematosus became pregnant if renal function was reasonably well preserved. Pregnancy infrequently posed a ser...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:1996-02-15 00:00:00
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更新日期:2012-07-03 00:00:00
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pub_type: 杂志文章
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更新日期:2010-11-16 00:00:00
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journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-3-341
更新日期:1981-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the relation between skeletal muscle disease (myopathy) and degenerative changes in cardiac muscle (cardiomyopathy) in patients with chronic alcoholism. DESIGN:A cross-sectional study. SETTING:University medical center. PARTICIPANTS:Group A included 24 patients with chronic alcoholism who had d...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-120-7-199404010-00001
更新日期:1994-04-01 00:00:00
abstract:OBJECTIVE:To assess internists' familiarity with, confidence in, and attitudes about practice guidelines issued by various organizations. DESIGN:Cross-sectional, self-administered survey. PARTICIPANTS:Questionnaires were mailed to a stratified random sample of 2600 members of the American College of Physicians (ACP) ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-120-11-199406010-00008
更新日期:1994-06-01 00:00:00
abstract:OBJECTIVE:To determine the toxicity and efficacy of low-dose interferon-alpha therapy in inducing remissions and prolonging survival in patients with chronic myeloid leukemia. DESIGN:Phase II evaluation and comparison with historical control patients and other series in which the investigators used higher interferon-a...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
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更新日期:1994-11-15 00:00:00
abstract::The relation of menopause to cardiovascular disease incidence was examined in women less than 55 years old from the cohort of 2873 women in the initial Framingham examination. Although the number of person-years of experience during the 20 years of observation was nearly the same for premenopausal and postmenopausal s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-85-4-447
更新日期:1976-10-01 00:00:00
abstract:Background:Whether statin type influences hepatocellular carcinoma (HCC) incidence or mortality in chronic hepatitis B or C virus infection is unknown. Objective:To assess the relationship between lipophilic or hydrophilic statin use and HCC incidence and mortality in a nationwide population with viral hepatitis. Des...
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pub_type: 杂志文章
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更新日期:2019-09-03 00:00:00
abstract:BACKGROUND:Questions remain about the importance of smoking and smoking cessation after incident myocardial infarction. OBJECTIVE:To assess the association between smoking status and risk for recurrent coronary events. DESIGN:Retrospective, population-based, inception cohort study. SETTING:Health maintenance organiz...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-137-6-200209170-00009
更新日期:2002-09-17 00:00:00