Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India
Introduction The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated...
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| description | Introduction The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. Objective To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India Methods We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with [greater than or equal to]10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged [greater than or equal to]40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. Results The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; â¹ 8,656) and single-stage (US$ 1073; â¹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. Conclusion In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels. |
| doi_str_mv | 10.1371/journal.pone.0285542 |
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The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. Objective To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India Methods We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with [greater than or equal to]10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged [greater than or equal to]40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. Results The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; â¹ 8,656) and single-stage (US$ 1073; â¹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. Conclusion In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0285542</identifier><identifier>PMID: 37624838</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular research ; Care and treatment ; Charts ; Computer and Information Sciences ; Cost analysis ; Decision trees ; Diabetes ; Disease prevention ; Economic aspects ; Effectiveness ; Health risk assessment ; Health risks ; Heart diseases ; Markov chains ; Medical care, Cost of ; Medical screening ; Medicine and Health Sciences ; Methods ; Mortality ; People and Places ; Physical Sciences ; Predictions ; Probability ; Public health ; Risk assessment ; Risk factors ; Screening ; Sensitivity analysis ; Social Sciences ; Strategy ; Stroke</subject><ispartof>PloS one, 2023-08, Vol.18 (8), p.e0285542-e0285542</ispartof><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Sivanantham 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>2023 Sivanantham et al 2023 Sivanantham et al</rights><rights>2023 Sivanantham 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><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4716-b72847a2c317c7039531c786f1770771d0049218794f3387789d1f2cc76d51e43</cites><orcidid>0000-0001-7122-523X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456130/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456130/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids></links><search><creatorcontrib>Sivanantham, Parthibane</creatorcontrib><creatorcontrib>S., Mathan Kumar</creatorcontrib><creatorcontrib>Essakky, Saravanan</creatorcontrib><creatorcontrib>Singh, Malkeet</creatorcontrib><creatorcontrib>Ghosh, Srobana</creatorcontrib><creatorcontrib>Mehndiratta, Abha</creatorcontrib><creatorcontrib>Kar, Sitanshu Sekhar</creatorcontrib><title>Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India</title><title>PloS one</title><description>Introduction The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. Objective To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India Methods We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with [greater than or equal to]10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged [greater than or equal to]40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. Results The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; â¹ 8,656) and single-stage (US$ 1073; â¹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. Conclusion In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.</description><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular research</subject><subject>Care and treatment</subject><subject>Charts</subject><subject>Computer and Information Sciences</subject><subject>Cost analysis</subject><subject>Decision trees</subject><subject>Diabetes</subject><subject>Disease prevention</subject><subject>Economic aspects</subject><subject>Effectiveness</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Heart diseases</subject><subject>Markov chains</subject><subject>Medical care, Cost of</subject><subject>Medical screening</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Mortality</subject><subject>People and Places</subject><subject>Physical Sciences</subject><subject>Predictions</subject><subject>Probability</subject><subject>Public health</subject><subject>Risk assessment</subject><subject>Risk factors</subject><subject>Screening</subject><subject>Sensitivity analysis</subject><subject>Social 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of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India</title><author>Sivanantham, Parthibane ; S., Mathan Kumar ; Essakky, Saravanan ; Singh, Malkeet ; Ghosh, Srobana ; Mehndiratta, Abha ; Kar, Sitanshu Sekhar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4716-b72847a2c317c7039531c786f1770771d0049218794f3387789d1f2cc76d51e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular research</topic><topic>Care and treatment</topic><topic>Charts</topic><topic>Computer and Information Sciences</topic><topic>Cost analysis</topic><topic>Decision trees</topic><topic>Diabetes</topic><topic>Disease prevention</topic><topic>Economic aspects</topic><topic>Effectiveness</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Heart diseases</topic><topic>Markov chains</topic><topic>Medical care, Cost of</topic><topic>Medical screening</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Mortality</topic><topic>People and Places</topic><topic>Physical Sciences</topic><topic>Predictions</topic><topic>Probability</topic><topic>Public health</topic><topic>Risk assessment</topic><topic>Risk factors</topic><topic>Screening</topic><topic>Sensitivity analysis</topic><topic>Social Sciences</topic><topic>Strategy</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sivanantham, Parthibane</creatorcontrib><creatorcontrib>S., Mathan Kumar</creatorcontrib><creatorcontrib>Essakky, Saravanan</creatorcontrib><creatorcontrib>Singh, Malkeet</creatorcontrib><creatorcontrib>Ghosh, Srobana</creatorcontrib><creatorcontrib>Mehndiratta, Abha</creatorcontrib><creatorcontrib>Kar, Sitanshu 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one</jtitle><date>2023-08-25</date><risdate>2023</risdate><volume>18</volume><issue>8</issue><spage>e0285542</spage><epage>e0285542</epage><pages>e0285542-e0285542</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Introduction The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. Objective To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India Methods We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with [greater than or equal to]10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged [greater than or equal to]40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. Results The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; â¹ 8,656) and single-stage (US$ 1073; â¹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. Conclusion In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>37624838</pmid><doi>10.1371/journal.pone.0285542</doi><orcidid>https://orcid.org/0000-0001-7122-523X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Cardiovascular disease Cardiovascular diseases Cardiovascular research Care and treatment Charts Computer and Information Sciences Cost analysis Decision trees Diabetes Disease prevention Economic aspects Effectiveness Health risk assessment Health risks Heart diseases Markov chains Medical care, Cost of Medical screening Medicine and Health Sciences Methods Mortality People and Places Physical Sciences Predictions Probability Public health Risk assessment Risk factors Screening Sensitivity analysis Social Sciences Strategy Stroke |
| title | Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India |
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