Evidence-based guidelines, time-based health outcomes, and the Matthew effect

Background: Cardiovascular risk management guidelines are ‘risk based’; health economists' practice is ‘time based’. The ‘medical’ risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model maximis...

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Vydané v:	European journal of public health Ročník 17; číslo 3; s. 314 - 317
Hlavní autori:	Essink-Bot, Marie-Louise, Kruijshaar, Michelle E, Barendregt, Jan J, Bonneux, Luc G A
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England Oxford University Press 01.06.2007
Predmet:	absolute risk Adult Age Age Factors Aged Cardiovascular Agents - supply & distribution Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - drug therapy Cardiovascular Diseases - mortality Deaths Disease prevention Drug dosages Drugs Epidemiology ethics Evidence-based medicine Evidence-Based Medicine - ethics Female Health Care Rationing - ethics Health Care Rationing - methods Health economics Health risks Health status High risk Humans Internet Life Life Expectancy life years gained Male Middle Aged Moral development Morals Netherlands - epidemiology Nonsmokers Numbers Obesity Older people Population distribution practice guidelines Practice Guidelines as Topic Prescription drugs Prevention Proportional Hazards Models Public health Quality-Adjusted Life Years Questionnaires Resource allocation Respondents Risk Assessment - ethics Risk Assessment - methods Risk Factors Risk management Smoking Socioeconomic factors Surveys and Questionnaires Time Time Factors Netherlands absolute risk cardiovascular disease resource allocation practice guidelines life years gained ethics evidence-based medicine
ISSN:	1101-1262, 1464-360X
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Shrnutí:	Background: Cardiovascular risk management guidelines are ‘risk based’; health economists' practice is ‘time based’. The ‘medical’ risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model maximises numbers of life years gained by treating the young and non-smokers, or ‘the one who has will be given more’ (Matthew 25:29). We explored practical consequences of risk- or time-based allocation. Methods: We used epidemiological modelling to generate semi-quantitative scenarios comparing the distributional effects of allocating a fixed number of prescriptions of a (hypothetical) preventive cardiovascular drug (‘CVStop’) either to avert the maximum number of deaths (risk-based) or to save the maximum number of life years (time based) in the male Dutch population. We subsequently asked 123 Dutch guideline developers which distribution they preferred. Results: Time- and risk-based allocations resulted in different distributions of the drug across the population. There were also differences in absolute numbers of life years gained and deaths averted, and in the distribution of these across the population. For example, risk-based allocation of ‘CVStop’ resulted in preferential treatment of elderly, leading to more deaths averted (mostly among 70 and above) but fewer life years gained, if compared with time-based allocation. The guideline developers experienced the choice dilemmas as difficult. No priority choice was dominant among the respondents. Conclusion: In evidence-based resource allocation the choice to save time or to avert deaths may introduce moral choices because of the various origins of increased disease risk. Evidence-based guideline development inevitably has moral implications.
Bibliografia:	ark:/67375/HXZ-1CFWHWGL-7 istex:331A08D866462AFD9751C16B9E2925A4344B95B1 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	1101-1262 1464-360X
DOI:	10.1093/eurpub/ckl238