tailieunhanh - Management of Acute Coronary Syndromes - part 10

như bệnh nhân trở thành tàn tật và yêu cầu dịch vụ chăm sóc sức khỏe trong những tháng và những năm tiếp theo. ACS đại diện cho một sự kiện cấp tính có thể tiếp tục chi phí, và do đó khác và phức tạp hơn một hình thức duy nhất của điều trị hoặc xét nghiệm chẩn đoán (Bảng 1). Khi xem xét một liệu pháp mới cho ACS | 706 Weintraub Table 1 What is Different About the Economics of ACS Episode in a chronic disease rather than a procedure. Clear starting point. No clear stopping point. Disease course may vary widely. Management may vary widely. Boundaries of what to include may be difficult. Indirect costs may be substantial. Health status may be affected significantly. as patients become disabled and require more health care services over the ensuing months and years. ACS represent an acute event that can have continuing costs and thus differs from and is more complicated than a single form of therapy or diagnostic test Table 1 . When considering a new therapy for ACS there is generally a clear starting point but often no clear stopping point other than death . The natural history of ACS may vary substantially as may management. The patient may be stable but then decompensate resulting in a hospitalization and intensified therapy presumably with a somewhat worse health state and associated costs. The goal of therapy is to return the patients to their baseline health state and maintain them there. Economic considerations should include direct cost as well as indirect costs which may be substantial due to lost productivity. ACS may also have a considerable impact on how people feel quality of life and how they function health status . A good design for an outcomes study in heart failure should take into account all of these possibilities. BACKGROUND ON ECONOMIC ANALYSES In an environment in which society cannot afford all possible medical services all forms of care compete for resources based on effectiveness and cost. A comparison of cost between contending therapies can involve a simulation in which costs and outcome are estimated from nonrandomized comparisons and randomized controlled trials. Even within randomized trials an economic analysis can range from a simulation to a very detailed component of the trial with extensive primary data collection. For any of these designs the

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