Frequency of Testing for Dyslipidemia: A Systematic Review and Budget Impact Analysis.
Notice bibliographique
Résumé
BACKGROUND: Current Canadian guidelines recommend annual screening for hyperlipidemia in people with a Framingham risk score (FRS) of greater than 5%. In those with a FRS of less than 5%, lipid screening is recommended every 3 to 5 years. OBJECTIVES: We aimed to determine the most cost-effective frequency of lipid profile testing in adults with different levels of cardiovascular risk based on published literature, to determine current frequency of lipid screening in Ontario, and to calculate the cost of aligning current with recommended frequencies. METHODS: We systematically searched for studies (from 2000 to 2012) evaluating the cost-effectiveness of lipid profile testing frequency in adults. Using the Canadian Community Health Survey and linked health administrative databases, we calculated the FRS for each survey respondent on every day from 2005 to 2011. Average current frequency of lipid testing was calculated according to the total number of patient days spent in each FRS category and the number of lipid tests occurring on those days. Extrapolating these outcomes to the Ontario population, we estimated the expected budget impact of aligning current rates of lipid testing with rates recommended by the Canadian Cardiovascular Society (CCS) guidelines. RESULTS: No studies evaluated the cost-effectiveness of lipid monitoring frequency. Our database analysis revealed that people in the very low risk group are tested an average of once every 4.4 years, those in the low risk group are tested once every 2 years, those in the intermediate risk group are tested every 1.4 years, and those in the highest risk group are tested annually. If we compare these rates to those recommended by the CCS guidelines, an additional 3.6 million tests would be needed to achieve recommended rates of lipid testing. At a cost of $14.48 per test, the expected cost to the province would be $52.2 million. LIMITATIONS: The results were analysed in aggregate, leading to the potential for ecological fallacy. In addition, because data pertaining to drug prescriptions in Ontario are only available for people over 65 years of age, the analysis did not account for the influence of statin treatment on the frequency of lipid testing. CONCLUSIONS: Our findings show that there is currently no evidence to inform the optimal frequency of lipid testing. People in Ontario at low-low, low, intermediate, and high risk are being tested once every 4.4, 1.9, 1.4, and 1.0 times per year, respectively. According to the CCS guidelines, this represents under-testing in the low and intermediate groups. Achieving the recommended rates of testing would cost approximately $52.2 million. Given the large cost of implementing such a change and the uncertainty on which CCS guidelines are based, it would be prudent to await the results of further research before making such a large investment.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,020 | 0,085 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,007 | 0,018 |
| Bibliométrie | 0,014 | 0,020 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».