| Titre : | Cost-effectiveness of vitamin therapy to lower plasma homocysteine levels for the prevention of Coronary Heart disease : effect of Grain fortification and beyond. (2001) |
| Auteurs : | Jeffrey-A TICE ; Pamela-G COXSON ; Paula-A GOLDMAN ; L.E.E. GOLDMAN ; Mgmyriam HUNINK ; Irwin ROSENBERG ; Elizabeth ROSS ; Milton-C WEINSTEIN ; Lawrence Williams ; Department of Health Policy and Management. Harvard School of Public Health. Boston. MA. USA ; Department of Medicine. University of California. San Francisco. USA ; Division of Clinical Nutrition. Tufts University. Boston. MA. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 286, n° 8, 2001) |
| Pagination : | 936-943 |
| Langues: | Anglais |
| Mots-clés : | Cardiopathie coronaire ; Etats Unis ; Amérique ; Plasma sanguin ; Thérapeutique médicamenteuse ; Chimiothérapie ; Analyse coût efficacité ; Etude comparée ; Supplémentation ; Prévention santé ; Adulte ; Homme ; Appareil circulatoire [pathologie] ; Thérapeutique ; Economie santé ; Amérique du Nord |
| Résumé : | [BDSP. Notice produite par INIST-CNRS HDR0xMla. Diffusion soumise à autorisation]. Context A high homocysteine level has been identified as an independent modifiable risk factor for coronary heart disease (CHD) events and death. Since January 1998, the US Food and Drug Administration has required that all enriched grain products contain 140 mug of folic acid per 100 g, a level considered to decrease homocysteine levels. Objectives To examine the potential effect of grain fortification with folic acid on CHD events and to estimate the cost-effectiveness of additional vitamin supplementation (folic acid and cyanocobalamin) for CHD prevention. Design and Setting Cost-effectiveness analysis using the Coronary Heart Disease Policy Model, a validated, state-transition model of CHD events in adults aged 35 through 84 years. Data from the third National Health and Nutrition Examination Survey (NHANES III) were used to estimate age-and sex-specific differences in homocysteine levels. Intervention Hypothetical comparison between a diet that includes enriched grain products projected to increase folic acid intake by 100 mug/d with the same diet without folic acid fortification ; and a comparison between vitamin therapy that consists of 1 mg of folic acid and 0.5 mg of cyanocobalamin and the diet that includes grains fortified with folic acid. Main Outcome Measures Incidence of myocardial infarction and death from CHD, quality-adjusted life-years (QALYs) saved, and medical costs. Results Grain fortification with folic acid was predicted to decrease CHD events by 8% in women and 13% in men, with comparable reductions in CHD mortality. The model projected that, compared with grain fortification alone, treating all patients with known CHD with folic acid and cyanocobalamin over a 10-year period would result in 310000 fewer deaths and lower costs. (...) |
Service Documentation EHESP
Me connecter
PORTAIL DOCUMENTAIRE
École des hautes études en santé publique
Catalogue
Multi-bases
Accueil
Sélection de la langue
Adresse
Service Documentation EHESPBibliothèque Rennes Avenue du Professeur Léon Bernard – CS 74312 – 35043 Rennes Cedex Bibliothèque MSSH Paris 20 avenue George Sand - 93210 La Plaine Saint-Denis
France
Bibliothèque Rennes : 02 99 02 29 50 Bibliothèque MSSH Paris : 02 99 02 24 50
contact