Simulating the impact of improved cardiovascular risk interventions on clinical and economic outcomes in Russia
Russia faces a high burden of cardiovascular disease. Prevalence of all cardiovascular risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment program...
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| description | Russia faces a high burden of cardiovascular disease. Prevalence of all cardiovascular risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment programs aimed at increasing blood pressure control would affect cardiovascular outcomes. In addition, we investigated what additional benefit adding lipid control and smoking cessation to blood pressure control would generate in terms of reduced cardiovascular events. Finally, we estimated the direct health care costs saved by treating fewer cardiovascular events.
The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure |
| doi_str_mv | 10.1371/journal.pone.0103280 |
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The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure <140 mmHg) of 40% and 60% were simulated by modifying adherence rates of an antihypertensive medication combination and compared with current care (23.9% blood pressure control rate). Outcomes of major adverse cardiovascular events; cerebrovascular event (stroke), myocardial infarction, and cardiovascular death over a 10-year time horizon were reported. Direct health care costs of strokes and myocardial infarctions were derived from official Russian statistics and tariff lists.
To achieve systolic blood pressure control rates of 40% and 60%, adherence rates to the antihypertensive treatment program were 29.4% and 65.9%. Cardiovascular death relative risk reductions were 13.2%, and 29.6%, respectively. For the current estimated 43,855,000-person Russian hypertensive population, each control-rate scenario resulted in an absolute reduction of 1.0 million and 2.4 million cardiovascular deaths, and a reduction of 1.2 million and 2.7 million stroke/myocardial infarction diagnoses, respectively. Averted direct costs from current care levels ($7.6 billion [in United States dollars]) were $1.1 billion and $2.6 billion, respectively.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0103280</identifier><identifier>PMID: 25141122</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Antihypertensive Agents - economics ; Antihypertensive Agents - therapeutic use ; Antihypertensives ; Biology and Life Sciences ; Blood ; Blood pressure ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - drug therapy ; Cardiovascular Diseases - economics ; Cardiovascular Diseases - physiopathology ; Cardiovascular Diseases - prevention & control ; Cardiovascular system ; Cerebral infarction ; Cerebrovascular system ; Computer and Information Sciences ; Computer simulation ; Cost-Benefit Analysis ; Costs ; Disease control ; Diuretics ; Drug addiction ; Drugs ; Health care ; Health Care Costs ; Health risk assessment ; Health risks ; Humans ; Hypertension ; Hypertension - drug therapy ; Hypertension - economics ; Hypertension - physiopathology ; Impact analysis ; Medical treatment ; Medication Adherence ; Metabolic disorders ; Models, Economic ; Models, Theoretical ; Mortality ; Myocardial infarction ; Preventive medicine ; Risk analysis ; Risk Factors ; Russia ; Smoking ; Tariffs</subject><ispartof>PloS one, 2014-08, Vol.9 (8), p.e103280-e103280</ispartof><rights>2014 Shum et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Shum et al 2014 Shum et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-22295797f2c4b6b42bf354e9d157a1bb7ebc6171d0fdc4799bd45eaf9d4399d3</citedby><cites>FETCH-LOGICAL-c456t-22295797f2c4b6b42bf354e9d157a1bb7ebc6171d0fdc4799bd45eaf9d4399d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139197/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139197/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25141122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Bullen, Chris</contributor><creatorcontrib>Shum, Kenny</creatorcontrib><creatorcontrib>Alperin, Peter</creatorcontrib><creatorcontrib>Shalnova, Svetlana</creatorcontrib><creatorcontrib>Boytsov, Sergey</creatorcontrib><creatorcontrib>Kontsevaya, Anna</creatorcontrib><creatorcontrib>Vigdorchik, Alexey</creatorcontrib><creatorcontrib>Guetz, Adam</creatorcontrib><creatorcontrib>Eriksson, Jennifer</creatorcontrib><creatorcontrib>Hughes, David</creatorcontrib><title>Simulating the impact of improved cardiovascular risk interventions on clinical and economic outcomes in Russia</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Russia faces a high burden of cardiovascular disease. Prevalence of all cardiovascular risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment programs aimed at increasing blood pressure control would affect cardiovascular outcomes. In addition, we investigated what additional benefit adding lipid control and smoking cessation to blood pressure control would generate in terms of reduced cardiovascular events. Finally, we estimated the direct health care costs saved by treating fewer cardiovascular events.
The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure <140 mmHg) of 40% and 60% were simulated by modifying adherence rates of an antihypertensive medication combination and compared with current care (23.9% blood pressure control rate). Outcomes of major adverse cardiovascular events; cerebrovascular event (stroke), myocardial infarction, and cardiovascular death over a 10-year time horizon were reported. Direct health care costs of strokes and myocardial infarctions were derived from official Russian statistics and tariff lists.
To achieve systolic blood pressure control rates of 40% and 60%, adherence rates to the antihypertensive treatment program were 29.4% and 65.9%. Cardiovascular death relative risk reductions were 13.2%, and 29.6%, respectively. For the current estimated 43,855,000-person Russian hypertensive population, each control-rate scenario resulted in an absolute reduction of 1.0 million and 2.4 million cardiovascular deaths, and a reduction of 1.2 million and 2.7 million stroke/myocardial infarction diagnoses, respectively. Averted direct costs from current care levels ($7.6 billion [in United States dollars]) were $1.1 billion and $2.6 billion, respectively.</description><subject>Antihypertensive Agents - economics</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Antihypertensives</subject><subject>Biology and Life Sciences</subject><subject>Blood</subject><subject>Blood pressure</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - drug therapy</subject><subject>Cardiovascular Diseases - economics</subject><subject>Cardiovascular Diseases - physiopathology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cardiovascular system</subject><subject>Cerebral infarction</subject><subject>Cerebrovascular system</subject><subject>Computer and Information Sciences</subject><subject>Computer simulation</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Disease control</subject><subject>Diuretics</subject><subject>Drug addiction</subject><subject>Drugs</subject><subject>Health care</subject><subject>Health Care Costs</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - economics</subject><subject>Hypertension - physiopathology</subject><subject>Impact analysis</subject><subject>Medical treatment</subject><subject>Medication Adherence</subject><subject>Metabolic disorders</subject><subject>Models, Economic</subject><subject>Models, Theoretical</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Preventive medicine</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Russia</subject><subject>Smoking</subject><subject>Tariffs</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNptkltr3DAQhU1paNK0_6C0gr70ZTcaXezVS6GEXgKBQJp3IUvyRltZs5Xshf77enedkJQ-aZC-OToznKp6B3QJvIGLDY45mbjcYvJLCpSzFX1RnYHibFEzyl8-qU-r16VsKJV8VdevqlMmQQAwdlbhz9CP0Qwhrclw70not8YOBLt9lXHnHbEmu4A7U-wEZpJD-UVCGnze-TQETIVgIjaGFKyJxCRHvMWEfbAEx8Fi78vEk9uxlGDeVCedicW_nc_z6u7b17vLH4vrm-9Xl1-uF1bIelgwxpRsVNMxK9q6FaztuBReOZCNgbZtfGtraMDRzlnRKNU6Ib3plBNcKcfPqw9H2W3EoudVFQ1SCrViNYWJuDoSDs1Gb3PoTf6j0QR9uMC81iYPwUavpWQMaivoijIhKahWKWO5opMHz52atD7Pv41t752d9pJNfCb6_CWFe73GnRbAFahmEvg0C2T8Pfoy6D4U62M0yeN48C1r1tAD-vEf9P_TiSNlM5aSffdoBqjex-ehS-_jo-f4TG3vnw7y2PSQF_4XoLzFAQ</recordid><startdate>20140820</startdate><enddate>20140820</enddate><creator>Shum, Kenny</creator><creator>Alperin, Peter</creator><creator>Shalnova, Svetlana</creator><creator>Boytsov, Sergey</creator><creator>Kontsevaya, Anna</creator><creator>Vigdorchik, Alexey</creator><creator>Guetz, Adam</creator><creator>Eriksson, Jennifer</creator><creator>Hughes, David</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20140820</creationdate><title>Simulating the impact of improved cardiovascular risk interventions on clinical and economic outcomes in Russia</title><author>Shum, Kenny ; Alperin, Peter ; Shalnova, Svetlana ; Boytsov, Sergey ; Kontsevaya, Anna ; Vigdorchik, Alexey ; Guetz, Adam ; Eriksson, Jennifer ; Hughes, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-22295797f2c4b6b42bf354e9d157a1bb7ebc6171d0fdc4799bd45eaf9d4399d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Antihypertensive Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shum, Kenny</au><au>Alperin, Peter</au><au>Shalnova, Svetlana</au><au>Boytsov, Sergey</au><au>Kontsevaya, Anna</au><au>Vigdorchik, Alexey</au><au>Guetz, Adam</au><au>Eriksson, Jennifer</au><au>Hughes, David</au><au>Bullen, Chris</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Simulating the impact of improved cardiovascular risk interventions on clinical and economic outcomes in Russia</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-08-20</date><risdate>2014</risdate><volume>9</volume><issue>8</issue><spage>e103280</spage><epage>e103280</epage><pages>e103280-e103280</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Russia faces a high burden of cardiovascular disease. Prevalence of all cardiovascular risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment programs aimed at increasing blood pressure control would affect cardiovascular outcomes. In addition, we investigated what additional benefit adding lipid control and smoking cessation to blood pressure control would generate in terms of reduced cardiovascular events. Finally, we estimated the direct health care costs saved by treating fewer cardiovascular events.
The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure <140 mmHg) of 40% and 60% were simulated by modifying adherence rates of an antihypertensive medication combination and compared with current care (23.9% blood pressure control rate). Outcomes of major adverse cardiovascular events; cerebrovascular event (stroke), myocardial infarction, and cardiovascular death over a 10-year time horizon were reported. Direct health care costs of strokes and myocardial infarctions were derived from official Russian statistics and tariff lists.
To achieve systolic blood pressure control rates of 40% and 60%, adherence rates to the antihypertensive treatment program were 29.4% and 65.9%. Cardiovascular death relative risk reductions were 13.2%, and 29.6%, respectively. For the current estimated 43,855,000-person Russian hypertensive population, each control-rate scenario resulted in an absolute reduction of 1.0 million and 2.4 million cardiovascular deaths, and a reduction of 1.2 million and 2.7 million stroke/myocardial infarction diagnoses, respectively. Averted direct costs from current care levels ($7.6 billion [in United States dollars]) were $1.1 billion and $2.6 billion, respectively.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25141122</pmid><doi>10.1371/journal.pone.0103280</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Antihypertensive Agents - economics Antihypertensive Agents - therapeutic use Antihypertensives Biology and Life Sciences Blood Blood pressure Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - drug therapy Cardiovascular Diseases - economics Cardiovascular Diseases - physiopathology Cardiovascular Diseases - prevention & control Cardiovascular system Cerebral infarction Cerebrovascular system Computer and Information Sciences Computer simulation Cost-Benefit Analysis Costs Disease control Diuretics Drug addiction Drugs Health care Health Care Costs Health risk assessment Health risks Humans Hypertension Hypertension - drug therapy Hypertension - economics Hypertension - physiopathology Impact analysis Medical treatment Medication Adherence Metabolic disorders Models, Economic Models, Theoretical Mortality Myocardial infarction Preventive medicine Risk analysis Risk Factors Russia Smoking Tariffs |
| title | Simulating the impact of improved cardiovascular risk interventions on clinical and economic outcomes in Russia |
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