ABSTRACT
OBJECTIVE: Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults. METHOD: Seven alternative strategies for hyperlipidemia screening were formulated and compared in terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. RESULTS: Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol,high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. CONCLUSIONS: Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.
Subject(s)
Adult , Humans , Cholesterol , Health Promotion , Hospitals, Teaching , Hyperlipidemias , Korea , Lipoproteins , Mass Screening , National Health Programs , TriglyceridesABSTRACT
BACKGROUND: Anxiety is a common disorder, but its diagnosis is often overlooked. Although there are several evaluating instruments, they are difficult to use in busy outpatient clinics because of its length. Furthermore, scales developed for screening are insufficient in the standardization. The purpose of this study is to measure reliability and validity of scale that can efficiently detect the anxiety patients in busy primary care setting. METHODS: With translation and assistance from psychiatrist, the questionnaire was developed. From March to July 2000, anxiety and control group at the department of family medicine in Seoul Joongang Hospital were tested with the questionnaire. After one week later, test was retaken. Reliability was verified by calculating Kappa value. Also validity was verified by comparing the scores between the anxiety group and the control group. Then sensitivity and specificity were evaluated, and the cutoff point was determined. RESULTS: Kappa values were ranging from 0.65 to 0.88. For each cutoff point 3, 4, 5, and 6 in total items, sensitivities were 99%, 97%, 82%, 64% and specificities were 55%, 75%, 94%, 98%, respectively. CONCLUSION: We translated an Goldberg's anxiety screening scale and estimated its reliability and validity. As the purpose was screening, we determined score 5 as the best cutoff points.