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: 10608166
• 负责人: Emily Parker Hyle
• 金额: $ 68.61万
• 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/10608166
• 关键词: 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; Resources; Risk; Risk Factors; Strategic vision; Structure; Time; Treatment Effectiveness; United States; Update; Vulnerable Populations; aged; antiretroviral therapy; cardiovascular disorder prevention; care costs; clinical care; clinically relevant; cohort; comorbidity; cost; cost effective; cost effectiveness; cost outcomes; dementia risk; depression model; design; 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，几乎一半被诊断出患有艾滋病毒的人年龄在50岁或50岁以上， 增加患痴呆症和多发性硬化症的风险。痴呆症是主要的临床政策关注，因为它的结果 在无情的临床下降和极高的护理成本。艾滋病毒感染者的风险特别高 因为他们通常具有发展痴呆症的传统病因的主要风险因素，例如 阿尔茨海默病和阿尔茨海默病相关痴呆（AD/ADRD），他们也有风险， HIV相关的神经认知疾病（HAND），尽管持续的病毒学抑制。抑郁症， 心血管疾病（CVD）和艾滋病毒已知有强大的协同作用，有助于发展 老年痴呆症众所周知，这些合并症是痴呆症的可改变风险因素，并且非常普遍 艾滋病毒感染者的治疗不足，可能是临床和经济上重要的预防目标 和管理 该提案的总体目标是提供一种循证方法，以确定优先事项并倡导 采取干预措施，提高艾滋病毒感染者的生活质量，降低发病率和死亡率。 减少艾滋病毒感染者抑郁和心血管疾病负担的好处目前可能是 由于时间短，往往没有捕捉到与多人同时受益的情况， 观察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，最具成本- 有效的是至关重要的理解，使艾滋病毒感染者可以受益于战略， 降低老年痴呆症和多发性痴呆症的风险。我们建议：1）发展认知 损伤、HIV、衰老、健康、精神健康和痴呆（CHARMED）模型，包括填充 模型的临床和结果数据来自北美艾滋病队列研究合作组织， 设计（NA-ACCORD）和国家代表性成本数据; 2） 艾滋病毒感染者的老龄化;以及3）对有针对性的干预措施进行成本效益分析，以减少 抑郁症和心血管疾病的负担，并量化由此产生的痴呆症和多发性硬化症的减少。 这项建议包括专家们在方法上的独特合作，这些方法是补充和必要的， 完成研究目标：临床专业知识，艾滋病病毒感染者的流行病学，成本计算，模拟 建模和成本效益分析。拟议的创新多形态模型将是第一个 包括这些非常普遍重要合并症，显示出协同作用，有助于 老年痴呆症，并适合治疗。模型结构和参数化都可以修改， 更新数据的出现以及对协同作用和病理生理学的更好理解。这 模拟建模方法将允许分析临床和政策问题，旨在改善临床 结果，提高生活质量，并降低艾滋病毒感染者的成本。