A cardiovascular disease policy model that predicts life expectancy taking into account socioeconomic deprivation

Lewsey, J.D. et al. (2014) A cardiovascular disease policy model that predicts life expectancy taking into account socioeconomic deprivation. Heart, 101(3), pp. 201-208. (doi:10.1136/heartjnl-2014-305637)

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Publisher's URL: http://heart.bmj.com/content/101/3/201

Abstract

Objectives: A policy model is a model that can evaluate the effectiveness and cost-effectiveness of interventions and inform policy decisions. In this study, we introduce a cardiovascular disease (CVD) policy model which can be used to model remaining life expectancy including a measure of socioeconomic deprivation as an independent risk factor for CVD.<p></p> Design: A state transition model was developed using the Scottish Heart Health Extended Cohort (SHHEC) linked to Scottish morbidity and death records. Individuals start in a CVD-free state and can transit to three CVD event states plus a non-CVD death state. Individuals who have a non-fatal first event are then followed up until death. Taking a competing risk approach, the cause-specific hazards of a first event are modelled using parametric survival analysis. Survival following a first non-fatal event is also modelled parametrically. We assessed discrimination, validation and calibration of our model.<p></p> Results: Our model achieved a good level of discrimination in each component (c-statistics for men (women)—non-fatal coronary heart disease (CHD): 0.70 (0.74), non-fatal cerebrovascular disease (CBVD): 0.73 (0.76), fatal CVD: 0.77 (0.80), fatal non-CVD: 0.74 (0.72), survival after non-fatal CHD: 0.68 (0.67) and survival after non-fatal CBVD: 0.65 (0.66)). In general, our model predictions were comparable with observed event rates for a Scottish randomised statin trial population which has an overlapping follow-up period with SHHEC. After applying a calibration factor, our predictions of life expectancy closely match those published in recent national life tables.<p></p> Conclusions: Our model can be used to estimate the impact of primary prevention interventions on life expectancy and can assess the impact of interventions on inequalities.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Briggs, Professor Andrew and Lewsey, Professor James and Kent, Mr Seamus and Watt, Professor Graham and Neilson, Dr Matthew and Ford, Professor Ian
Authors: Lewsey, J.D., Lawson, K.D., Ford, I., Fox, K.A.A., Ritchie, L.D., Tunstall-Pedoe, H., Watt, G.C.M., Woodward, M., Kent, S., Neilson, M., and Briggs, A.H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Copyright Holders:Copyright © 2014 The Authors
First Published:First published in Heart 2014
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
487321From absolute risk to absolute benefit in the prevention of cardiovascular disease: a cardiovascular policy model for Scotland (ASSIGN Plus)Andrew BriggsScottish Executive Health Department (SEHHD-CSO)CZH/4/557IHW - HEALTH ECON & TECH ASSESSMENT