社區高血脂篩檢流行病學評估及成本效益分析
Date Issued
2003-07-31
Date
2003-07-31
Author(s)
曾春典
DOI
912320B002172
Abstract
Although cholesterol has been regarded
as the most influence risk factor for
cardiovascular disease, in particular ischemic
heart disease, whether a single lipid index is
appropriate for screening for cardiovascular
disease and whether the optimal cutoff point
can be obtain are uncertain. This may depend
on the presence of risk factors and on
whether cases come from clinical series or
community subjects with asymptomatic
syndrome. In addition, inconsistent results
were also found among large clinical trials
that found the effectiveness of
anti-cholesterol drugs also depends on the
presence risk factors in individuals.
Preventive strategies for cardiovascular
disease have two approaches, high-risk group
approach, and population-wide strategy.
However, which strategy is appropriate is in
dilemma. The above findings imply that
cost-effectiveness for lipid screening should
encompass lipid screening index, the efficacy
3
of treatment, and screening strategies.
Objectives: The purposes are to
(1) estimate abnormality of lipid and their
association with cardiovascular disease;
(2) elucidate the association between lipids
and cardiovascular disease after
adjustment for relevant factors;
(3) to identify the optimal cut-off point given
a combination of LDL, TC/HDL using
Receiver Operating Characteristics curve;
(4) to develop a multiple index using
Bayesian sequential method to obtain the
optimal sensitivity and specificity and to
compare the result with those paid by
health insurance.
Results: Taking 240 mg/dl as the cut-off
point of cholesterol the sensitivity and
specificity were 11% and 94%. The
corresponding figures were 55% and 42% for
HDL≦35 mg/dl and 4% and 98% for LDL≧
160mg/dl. Using Bayesian Analysis, given
240mg/dl of cholesterol, the odd ratios were
increased from 0.09 to 11.42 with the
corresponding range of HDL from 80mg/dlto
10mg/dl.
Conclusion:
The optional cut-off point of the combination
of lipid profiles were estimated using
Bayesian Approach.
Subjects
lipid screening
community-based study
ROC curve
cost-effectiveness analysis
SDGs
Publisher
臺北市：國立臺灣大學公共衛生學院預防醫學研究所
Type
report
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