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.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Bonds, Denise
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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Pandya, Ankur; Sy, Stephen; Cho, Sylvia et al. (2017) Validation of a Cardiovascular Disease Policy Microsimulation Model Using Both Survival and Receiver Operating Characteristic Curves. Med Decis Making 37:802-814
Dugani, Sagar; Gaziano, Thomas A (2016) 25 by 25: Achieving Global Reduction in Cardiovascular Mortality. Curr Cardiol Rep 18:10
Gaziano, Thomas; Abrahams-Gessel, Shafika; Surka, Sam et al. (2015) Cardiovascular Disease Screening By Community Health Workers Can Be Cost-Effective In Low-Resource Countries. Health Aff (Millwood) 34:1538-45
Gaziano, Thomas A (2015) The Devil Is in the Details: Achieving Reductions in Global Cardiovascular Disease Mortality. Circ Cardiovasc Qual Outcomes 8:535-8
Lubitz, Carrie C; Economopoulos, Konstantinos P; Sy, Stephen et al. (2015) Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circ Cardiovasc Qual Outcomes 8:621-30
Pandya, Ankur; Weinstein, Milton C; Gaziano, Thomas A (2015) Cost-effectiveness of Statin Therapy for ASCVD--Reply. JAMA 314:2191-2
Gaziano, Thomas; Cho, Sylvia; Sy, Stephen et al. (2015) Increasing Prescription Length Could Cut Cardiovascular Disease Burden And Produce Savings In South Africa. Health Aff (Millwood) 34:1578-85
Pandya, Ankur; Sy, Stephen; Cho, Sylvia et al. (2015) Cost-effectiveness of 10-Year Risk Thresholds for Initiation of Statin Therapy for Primary Prevention of Cardiovascular Disease. JAMA 314:142-50
Peer, Nasheeta; Lombard, Carl; Steyn, Krisela et al. (2014) Comparability of total cardiovascular disease risk estimates using laboratory and non-laboratory based assessments in urban-dwelling South Africans: the CRIBSA study. S Afr Med J 104:691-6
Pandya, Ankur; Weinstein, Milton C; Salomon, Joshua A et al. (2014) Who needs laboratories and who needs statins?: comparative and cost-effectiveness analyses of non-laboratory-based, laboratory-based, and staged primary cardiovascular disease screening guidelines. Circ Cardiovasc Qual Outcomes 7:25-32

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