Abstract:
OBJECTIVES:To estimate the cost effectiveness of statins in lowering serum cholesterol concentration in people at varying risk of fatal cardiovascular disease and to explore the implications of changing the criteria for intervention on cost and cost effectiveness for a purchasing authority. DESIGN:A life table method was used to model the effect of treatment with a statin on survival over 10 years in men and women aged 45-64. The costs of intervention were estimated from the direct costs of treatment, offset by savings associated with a reduction in coronary angiographies, non-fatal myocardial infarctions, and revascularisation procedures. The robustness of the model to various assumptions was tested in a sensitivity analysis. SETTING:Population of a typical district health authority. MAIN OUTCOME MEASURE:Cost per life year saved. RESULTS:The average cost effectiveness of treating men aged 45-64 with no history of coronary heart disease and a cholesterol concentration > 6.5 mmol/l for 10 years with a statin was 136,000 pounds per life year saved. The average cost effectiveness for patients with pre-existing coronary heart disease and a cholesterol concentration > 5.4 mmol/l was 32,000 pounds. These averages hide enormous differences in cost effectiveness between groups at different risk, ranging from 6000 pounds per life year in men aged 55-64 who have had a myocardial infarction and whose cholesterol concentration is above 7.2 mmol/l to 361,000 pounds per life year saved in women aged 45-54 with angina and a cholesterol concentration of 5.5-6.0 mmol/l. CONCLUSIONS:Lowering serum cholesterol concentration in patients with and without preexisting coronary heart disease is effective and safe, but treatment for all those in whom treatment is likely to be effective is not sustainable within current NHS resources. Data on cost effectiveness data should be taken into account when assessing who should be eligible for treatment.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Pharoah PD,Hollingworth Wdoi
10.1136/bmj.312.7044.1443subject
Has Abstractpub_date
1996-06-08 00:00:00pages
1443-8issue
7044eissn
0959-8138issn
1756-1833journal_volume
312pub_type
杂志文章abstract:OBJECTIVE:To report the percentage of graduates from British medical schools who eventually practise medicine in the British NHS. DESIGN:Cohort studies using postal questionnaires, employment data, and capture-recapture analysis. SETTING:Great Britain. SUBJECTS:32 430 graduates from all British medical schools in ni...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.b1977
更新日期:2009-06-03 00:00:00
abstract:OBJECTIVE:To compare the effects of treatments for coronavirus disease 2019 (covid-19). DESIGN:Living systematic review and network meta-analysis. DATA SOURCES:WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2020 and six additional Chinese databases up to 12 ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m2980
更新日期:2020-07-30 00:00:00
abstract:OBJECTIVE:To determine whether failure to adequately adjust for a reported 40% misclassification of use of in vitro fertilisation (IVF) as reported in a Swedish study could have led to a false finding that folic acid increases dizygotic twinning. DESIGN:Modelling with population based data. SETTING:Swedish vital reco...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38369.437789.82
更新日期:2005-04-09 00:00:00
abstract:OBJECTIVE:To describe the time distribution of visits at night and to evaluate trends in night visits from 1982 to 1992. DESIGN:Analysis of a sample of one in 12 claim forms for night visits submitted over one year beginning 1 July 1991, and estimation of the number of night visits in previous years from data on payme...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6880.762
更新日期:1993-03-20 00:00:00
abstract:OBJECTIVE:To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing. DESIGN:Randomised trial with eight groups (three factors, 2x2x2). Data collected at...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.38807.571042.68
更新日期:2006-04-22 00:00:00
abstract:OBJECTIVES:To determine prospectively the rates of change in bone mineral density in elderly people and to examine the relation between lifestyle and demographic factors and these rates of change. DESIGN:Longitudinal population based study. SETTING:Dubbo, New South Wales, Australia. SUBJECTS:Representative sample (n...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:
更新日期:1994-09-17 00:00:00
abstract:OBJECTIVE:To examine differences in morbidity and mortality due to non-insulin dependent diabetes in African Caribbeans and Europeans. DESIGN:Cohort study of patients with non-insulin dependent diabetes drawn from diabetes clinics in London. Baseline investigations were performed in 1975-7; follow up continued until 1...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7061.848
更新日期:1996-10-05 00:00:00
abstract:OBJECTIVE:To examine the protective efficacy of measles vaccination in infants in a low income country before 9 months of age. DESIGN:Randomised clinical trial. PARTICIPANTS:1333 infants aged 4.5 months: 441 in treatment group and 892 in control group. SETTING:Urban area in Guinea-Bissau. INTERVENTION:Measles vacci...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.a661
更新日期:2008-07-24 00:00:00
abstract:OBJECTIVE:To synthesise the views of patients and carers in decision making regarding treatment for chronic kidney disease, and to determine which factors influence those decisions. DESIGN:Systematic review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care, and them...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.c112
更新日期:2010-01-19 00:00:00
abstract:OBJECTIVE:To determine whether a relation between urinary retention and temporal rhythms exists. DESIGN:Retrospective analysis of patients presenting over three years. SETTING:Urology departments in two hospitals. PATIENTS:815 Patients presenting as emergency admissions with urinary retention and requiring immediate...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6715.1560
更新日期:1989-12-23 00:00:00
abstract:OBJECTIVE:To evaluate the safety of withholding anticoagulant treatment from patients with clinically suspected deep vein thrombosis but normal findings on compression ultrasonography. DESIGN:Compression ultrasonography was done with a simplified diagnostic procedure limited to the common femoral vein in the groin and...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.316.7124.17
更新日期:1998-01-03 00:00:00
abstract:OBJECTIVE:To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. DATA SOURCES:Cochrane Library, Medline (1996-2000), Embase, Current Contents, and Cancerlit databases as well as hand searching. STUDY SELECTION:Studies were included if a physician's tem...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.327.7408.195
更新日期:2003-07-26 00:00:00
abstract:OBJECTIVE:To compare health behaviours during pregnancy (smoking and alcohol consumption) and after birth (initiation and duration of breast feeding) between British/Irish white mothers and mothers from ethnic minority groups; and, in mothers from ethnic minority groups, to examine whether indicators of acculturation (...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.39532.688877.25
更新日期:2008-05-10 00:00:00
abstract::In prospective studies, the prevalence of undiagnosed subclinical hypothyroidism in pregnant women ranges from 3% to 15%. Subclinical hypothyroidism is associated with multiple adverse outcomes in the mother and fetus, including spontaneous abortion, pre-eclampsia, gestational hypertension, gestational diabetes, prete...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.g4929
更新日期:2014-10-06 00:00:00
abstract:OBJECTIVES:To determine whether over the counter cough medicines are effective for acute cough in adults. DESIGN:Systematic review of randomised controlled trials. DATA SOURCES:Search of the Cochrane Acute Respiratory Infections Group specialised register, Cochrane Controlled Trials Register, Medline, Embase, and the...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.324.7333.329
更新日期:2002-02-09 00:00:00
abstract:OBJECTIVE:To assess the effect of weight loss induced by a very low energy diet on moderate and severe obstructive sleep apnoea in obese men. Design Single centre, two arm, parallel, randomised, controlled, open label trial. Blocked randomisation procedure used for treatment allocation. Setting Outpatient obesity clini...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.b4609
更新日期:2009-12-03 00:00:00
abstract:OBJECTIVE:To determine cancer morbidity in members of the armed forces who took part in tests of chemical warfare agents from 1941 to 1989. DESIGN:Historical cohort study, with cohort members followed up to December 2004. DATA SOURCE:Archive of UK government research facility at Porton Down, UK military personnel rec...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.b655
更新日期:2009-03-24 00:00:00
abstract:OBJECTIVE:To describe the experiences of authors of Cochrane reviews in searching for, getting access to, and using unpublished data. DESIGN:Cross sectional study. SETTING:Cochrane reviews. PARTICIPANTS:2184 corresponding authors of Cochrane reviews as of May 2012. MAIN OUTCOME MEASURE:Frequencies of responses to o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f2231
更新日期:2013-04-23 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy and safety of 4% dimeticone lotion for treatment of head louse infestation. DESIGN:Randomised controlled equivalence trial. SETTING:Community, with home visits. PARTICIPANTS:214 young people aged 4 to 18 years and 39 adults with active head louse infestation. INTERVENTIONS:Two app...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.38497.506481.8F
更新日期:2005-06-18 00:00:00
abstract:OBJECTIVE:To investigate whether users of oral contraceptives and in [corrected] carriers of a hereditary prothrombotic condition (factor V Leiden mutation, protein C, S, or antithrombin deficiency) have an increased risk of cerebral sinus thrombosis. DESIGN:Comparison of a prospective series of cases of cerebral sinu...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.316.7131.589
更新日期:1998-02-21 00:00:00
abstract:OBJECTIVE:To evaluate the effect of support with human chorionic gonadotrophin in the luteal phase in women taking part in an in vitro fertilisation programme after buserelin and human menopausal gonadotrophin were used to hyperstimulate their ovaries. DESIGN:Controlled group comparison. SETTING:Outpatient department...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.298.6686.1483
更新日期:1989-06-03 00:00:00
abstract:OBJECTIVE:To compare perinatal outcomes in births of women with versus without a history of bariatric surgery. DESIGN:Population based matched cohort study. SETTING:Swedish national health service. PARTICIPANTS:1,742,702 singleton births identified in the Swedish medical birth register between 1992 and 2009. For eac...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f6460
更新日期:2013-11-12 00:00:00
abstract::Objective To estimate the cumulative radiation exposure and lifetime attributable risk of cancer incidence associated with lung cancer screening using annual low dose computed tomography (CT).Design Secondary analysis of data from a lung cancer screening trial and risk-benefit analysis.Setting 10 year, non-randomised,...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j347
更新日期:2017-02-08 00:00:00
abstract:OBJECTIVES:To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales. DESIGN:Inspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical gui...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.315.7120.1420
更新日期:1997-11-29 00:00:00
abstract:OBJECTIVE:To investigate pharmaceutical or medical device industry funding of patient groups. DESIGN:Systematic review with meta-analysis. DATA SOURCES:Ovid Medline, Embase, Web of Science, Scopus, and Google Scholar from inception to January 2018; reference lists of eligible studies and experts in the field. ELIGIB...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.l6925
更新日期:2020-01-22 00:00:00
abstract::A study was conducted (a) to assess the number of patients registered with a south London general practice who over 11 weeks referred themselves to an accident and emergency department, (b) to identify the characteristics of those patients, and (c) to determine their perceptions of the services and resources available...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6657.1179
更新日期:1988-11-05 00:00:00
abstract::Robots designed for surgery have three main advantages over humans. They have greater three dimensional spatial accuracy, are more reliable, and can achieve much greater precision. Although few surgical robots are yet in clinical trials one or two have advanced to the stage of seeking approval from the UK's Medical De...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.311.7018.1479
更新日期:1995-12-02 00:00:00
abstract:OBJECTIVE:To determine whether any association exists between exposure to 2009 pandemic H1N1 (pH1N1) influenza vaccination during pregnancy and negative health outcomes in early childhood. DESIGN:Retrospective cohort study. SETTING:Population based birth registry linked with health administrative databases in the pro...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.l4151
更新日期:2019-07-10 00:00:00
abstract:OBJECTIVE:To study the dynamic function of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome. DESIGN:Prospective comparison of patients with postviral fatigue syndrome with two control groups. SETTING:Department of neurology, University of Glasgow, Southern General Hospital; depar...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6833.1010
更新日期:1992-04-18 00:00:00
abstract:OBJECTIVE:To investigate whether paracetamol (acetaminophen) plus ibuprofen are superior to either drug alone for increasing time without fever and the relief of fever associated discomfort in febrile children managed at home. DESIGN:Individually randomised, blinded, three arm trial. SETTING:Primary care and househol...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.a1302
更新日期:2008-09-02 00:00:00