Cost-effective prevention of cardiovascular disease

描述（由申请人提供）：这个国际研究科学家发展奖的目的是准备申请人，托马斯A Gaziano，职业生涯作为一个独立的调查员在成本效益预防心血管疾病（CVD）在发展中国家。Gaziano博士建议在美国的两个已建立的队列中设计一种简单的无血筛查工具，用于预测CVD风险最高的人群，然后评估南非和印度这种策略的成本效益。目前的国际指南根据多种风险因素（包括胆固醇和糖尿病状态）评估CVD风险。然而，血液检测的成本和缺乏训练有素的工作人员来获取样本，使这些准则在发展中国家不切实际。研究计划包括三个具体目标。1.开发一种简单的筛选机制，具有容易获得的CVD风险因素-年龄，烟草，收缩压和肥胖测量（BMI）-并将其与常用的工具进行比较，除了年龄，烟草状况和血压外，还需要昂贵的血脂和葡萄糖抽血。2.在一项成本效益分析中，使用以下策略比较特定目标1中推导出的两种CVD筛查工具：无血液采样筛查、有血液采样筛查和第三种策略，即两步过程，首先评估风险，但不进行血液检测，以确定可能从较高成本的血液检测筛查中获益的人群子集。该分析将基于印度CVD哨点监测研究和南非人口与健康调查中的成本和风险因素患病率数据。3.使用简化的风险评分和状态转换模型来改善对南非和印度潜在负担疾病的估计。

DESCRIPTION (provided by applicant): The purpose of this International Research Scientist Development Award is to prepare the applicant, Thomas A Gaziano, for a career as an independent investigator in cost-effective prevention of cardiovascular disease (CVD) in developing countries. Dr. Gaziano proposes to devise a simple bloodless screening tool in two established cohorts in the US for predicting those at highest risk for CVD and then to assess the cost effectiveness of such a strategy in South Africa and India. Current international guidelines assess risk of CVD on the basis of multiple risk factors including cholesterol and diabetes status. However, the cost of blood testing and a lack of trained staff to obtain samples make these guidelines impractical in developing countries. The research plan consists of three specific aims. 1. To develop a simple screening mechanism with easily obtainable risk factors for CVD --age, tobacco, systolic blood pressure, and an obesity measure (BMI)-- and compare it to a commonly used tool requiring costly blood drawing of lipids and glucose in addition to age, tobacco status, and blood pressure. 2. To compare the two screening tools for CVD derived in specific aim 1 in a cost-effective analysis using the following strategies: screening without blood sampling, screening with blood sampling, and a third strategy of a two step process of first assessing risk with no blood testing to identify a subset of the population who might benefit from higher cost screening with blood testing. This analysis will be based on cost and risk factor prevalence data in the Sentinel Surveillance for CVD in India Study and the Demographic and Health Survey in South Africa. 3. Using the simplified risk score, and the state-transition model to improve estimates of the potential burden disease in South Africa and India.