Global Cardiovascular Disease Policy Model for Screening Prevention and Treatment

描述（由申请人提供）：该项目的目的是开发一个综合心血管疾病（CVD）预防模型，该模型可用于估计美国35岁以上人群和几个亚人群中冠心病、中风和充血性心力衰竭（CHF）的各种筛查、预防和治疗策略的健康和经济后果。该项目旨在帮助实现2007年制定的《国家卫生和社会福利机构战略计划》的战略目标3，即“将研究转化为实践”，具体应对挑战3.2，即“确定具有成本效益的预防、诊断和治疗方法”。CVD预防模型将是一个全面的模型，包括冠心病、心力衰竭、中风及其危险因素，以及与CVD护理相关的成本。该模型可拟合观察到的流行病学数据、自然历史数据、微观模拟模型将使用最佳可用数据进行参数化，然后使用基于似然的方法对美国人口数据进行校准，该方法正式比较每个独特参数集产生的模型结果与基于流行病学数据的目标的匹配程度。例如年龄和其他风险因素以及疾病发病率。模型结局包括中期结局（如心肌梗死、卒中、导管插入术次数和CHF住院）以及长期结局（如冠心病发病率和死亡率、预期寿命、质量调整预期寿命和终身成本）。它将纳入基于NHANES研究和其他来源的美国人口中的风险因素分布，风险因素随年龄的变化，风险因素与疾病发病率之间的数学关系。该模式还将纳入基于人口和个人的预防性干预措施的有效性和成本。它将纳入筛查的敏感性、特异性、成本和风险，以及早期干预的成本和风险。它的设计目的是根据人口和社会经济特征，如种族、民族和职业，对特定的亚人口进行分析。该模型还将针对美国和南非的几个亚种群进行校准。

DESCRIPTION (provided by applicant): The purpose of this project is to develop an integrated Cardiovascular Disease (CVD) Prevention Model which can be used to estimate the health and economic consequences of various screening, prevention, and treatment strategies for coronary heart disease, stroke, and congestive heart failure (CHF) in the U.S. population over the age of 35 and several subpopulations. The project is to help achieve strategic Goal 3 of the NHLBI Strategic Plan set out in 2007 to "translate research into practice" by specifically answering Challenge 3.2 to "identify cost-effective approaches to prevention, diagnosis and treatment". The CVD Prevention Model will be a comprehensive model of CHD, CHF, stroke and their risk factors as well as the costs related to care for CVD. The model will be fit to the observed epidemiological data, natural history data, and trends from the published literature and publicly available databases in the US with the flexibility to be adapted to other developing regions and sub-populations of the U.S. The micro-simulation model will be parameterized using the best available data and is then calibrated to U.S. population data using a likelihood- based approach that formally compares how well model outcomes produced by each unique parameter set match targets based on epidemiologic data, such as age- and other risk factors as well as disease incidence rates. Model outcomes include intermediate outcomes (e.g., cases of myocardial infarction, stroke, number of catheterizations, and CHF hospitalizations) as well as long-term outcomes (e.g., CHD incidence and mortality, life expectancy, quality-adjusted life expectancy, and lifetime costs). It will incorporate risk factor distributions in the U.S. population based on NHANES studies and other sources, changes in risk factors with age, mathematical relationships between risk factors and disease incidence. The model will also incorporate the effectiveness and costs of population and individually based preventive interventions. It will incorporate the sensitivity, specificity, costs, and risks of screening, and the costs and risks of early intervention. It will be designed so that analyses can be conducted for specific subpopulations defined according to demographic and socio- economic characteristics such as race, ethnicity, and occupation. The model will also be calibrated to several subpopulations in the U.S. as well as to the country of South Africa. PUBLIC HEALTH RELEVANCE: The purpose of this project is to develop a Cardiovascular Disease Prevention Model which can be used to estimate the health and economic consequences of cardiovascular screening, treatment, and prevention interventions in the U.S. population and several subpopulations. The model will involve the relationship between lifestyle, and environmental risk factors for the development of the three main contributors of cardiovascular disease (CVD) morbidity and mortality-CHD, CHF, and stroke. It will incorporate the sensitivity, specificity, costs, and benefits of screening, and the costs and benefits of early intervention.