The CHARMED model: a multimorbidity simulation model for people aging with HIV

CHARMED 模型：针对艾滋病毒老年患者的多发病模拟模型

• 批准号: 10378711
• 负责人: Emily Parker Hyle
• 金额: $ 71.07万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10378711
• 关键词: AIDS dementia; Acquired Immunodeficiency Syndrome; Address; Advocate; Age; Age-Years; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Area; Cardiovascular Diseases; Caring; Chronic Disease; Clinical; Clinical Trials; Cohort Studies; Collaborations; Cost Analysis; Cost Effectiveness Analysis; Cost of Illness; Data; Dementia; Development; Diagnosis; Disease; Disease Outcome; Disease model; Economics; Epidemiology; Etiology; Event; Functional disorder; Future; General Population; Goals; Guidelines; HIV; Health Care Costs; Heart; Impaired cognition; Incidence; Individual; International; Intervention; Life Expectancy; Major Depressive Disorder; Mental Depression; Mental Health; Methods; Modeling; Morbidity - disease rate; National Institute on Aging; Neurocognitive; Outcome; Patients; Persons; Policies; Population; Prevention; Prevention strategy; Public Health; Quality of life; Recording of previous events; Research; Research Design; Resources; Risk; Risk Factors; Strategic vision; Structure; Time; Treatment Effectiveness; United States; Update; Vulnerable Populations; aged; antiretroviral therapy; cardiovascular disorder prevention; care costs; care outcomes; clinical care; clinically relevant; cohort; comorbidity; cost; cost effective; cost effectiveness; cost outcomes; dementia risk; depression model; economic outcome; effective therapy; evidence base; experience; high risk; improved; innovation; interest; life time cost; models and simulation; modifiable risk; mortality; mortality risk; multidisciplinary; multiple chronic conditions; novel; prevent; synergism

PROJECT SUMMARY Almost half of all people diagnosed with HIV in the United States are aged 50 or older, and they are at increased risk for dementia and multimorbidity. Dementia is of major clinical policy concern because it results in both inexorable clinical decline and extremely high costs of care. People with HIV are at particularly high risk because they often have major risk factors for the development of traditional etiologies of dementia, such as Alzheimer's Disease and Alzheimer's Disease-Related Dementias (AD/ADRD), and they also have a risk of HIV-associated neurocognitive disease (HAND) despite sustained virologic suppression. Depression, cardiovascular disease (CVD), and HIV are known to have potent synergies that contribute to the development of dementia. These comorbidities are modifiable risk factors for dementia that are highly prevalent, known to be undertreated in people with HIV, and likely to be clinically and economically important targets for prevention and management. The overall goal of this proposal is to provide an evidence-based approach for prioritizing and advocating for interventions to improve the quality of life and reduce morbidity and mortality among people aging with HIV. The benefits of reducing the burden of depression and CVD among people with HIV may currently be underestimated, given that concomitant benefits related to multimorbidity are often not captured due to short durations of observational or trial data. Determining which interventions are most clinically effective and cost- effective is critically important to understand so that people aging with HIV can benefit from strategies to reduce their risk of dementia and multimorbidity as they age. We propose to: 1) develop the Cognitive impairment, HIV, Aging, heaRt, MEntal health, and Dementia (CHARMED) Model, including populating the model with clinical and outcomes data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and nationally-representative cost data; 2) project clinical and economic outcomes of people aging with HIV; and 3) perform cost-effectiveness analyses of targeted interventions to reduce the burden of depression and CVD and to quantify the resultant reduction in dementia and multimorbidity. This proposal comprises a unique collaboration of experts in methods that are complementary and essential to complete the research aims: clinical expertise, epidemiology of people aging with HIV, costing, simulation modeling, and cost-effectiveness analysis. The proposed innovative multimorbidity model will be the first to include these important comorbidities that are highly prevalent, demonstrate synergies that contribute to dementia, and are amenable to treatment. The model structure and parameterization can both be revised with the emergence of updated data and improved understanding of the synergies and pathophysiology. This simulation modeling approach will allow for analyses of clinical and policy questions that aim to improve clinical outcomes, improve quality of life, and reduce costs among people aging with HIV.

项目摘要 在美国被诊断出艾滋病毒的所有患者中，几乎一半是50岁以上的人，他们在 增加痴呆症和多种病的风险。痴呆是主要的临床政策问题，因为它会导致 在无法造成的临床下降和极高的护理成本中。艾滋病毒患者特别高的风险 因为它们通常有主要的危险因素来发展传统痴呆症的病因，例如 阿尔茨海默氏病和阿尔茨海默氏病有关的痴呆症（AD/ADRD），它们也有可能 尽管持续的病毒学抑制，与HIV相关的神经认知疾病（手）。沮丧， 众所周知，心血管疾病（CVD）和艾滋病毒具有有效的协同作用，有助于发展 痴呆症。这些合并症是痴呆症的可修改风险因素，高度普遍，已知 在患有艾滋病毒的患者中未治疗，并且在临床和经济上可能是预防的目标 和管理。 该提案的总体目标是提供基于证据的方法来优先和倡导 改善生活质量并降低艾滋病毒衰老的人的发病率和死亡率的干预措施。 艾滋病毒患者中减轻抑郁和CVD负担的好处可能是 被低估的，鉴于与多发病有关 观察性或试验数据的持续时间。确定哪些干预措施在临床上最有效且成本 - 有效理解非常重要 随着年龄的增长，降低了痴呆症和多种病的风险。我们建议：1）发展认知 损害，艾滋病毒，衰老，心脏，心理健康和痴呆症（Charmed）模型，包括居住 来自北美艾滋病研究协作的临床和结果数据的模型 设计（NA-Accord）和全国代表性的成本数据； 2）项目的临床和经济成果 患有艾滋病毒的人； 3）对有针对性干预措施进行成本效益分析以减少 抑郁症和CVD负担，并量化痴呆症和多种症状的减少。 该建议包括专家在方法中的独特合作，这些方法是互补且对 完成研究目的：临床专业知识，患者衰老的人流行病学，成本核算，模拟 建模和成本效益分析。拟议的创新多发性模型将是第一个 包括这些非常普遍的重要合并症，证明了有助于的协同作用 痴呆症，并且可以接受治疗。模型结构和参数化都可以通过 更新数据的出现以及对协同生理学和病理生理学的了解。这 仿真建模方法将允许分析旨在改善临床的临床和政策问题 结果，改善生活质量并降低艾滋病毒衰老的人的成本。