The German Coronary Artery Disease Risk Screening Model: Development,Validation,and Application of a Decision-Analytic Model for Coronary Artery Disease Prevention with Statins
Restricted accessOtherFirst published online September, 2009
The German Coronary Artery Disease Risk Screening Model: Development,Validation,and Application of a Decision-Analytic Model for Coronary Artery Disease Prevention with Statins
Background. Coronary artery disease (CAD) is a major cause of death in industrial countries, leading to high health-related costs and decreased quality of life. Objective. To develop and validate a decision-analytic model for CAD risk screening in Germany (German Coronary Artery Disease Screening Model). Design. Markov model. Target Population. Age- and gender-specific cohorts of the German population. Data Sources. Mortality rates posted by the German Federal Statistical Office, the German Health Survey, social health insurance institutions, the MONICA Augsburg study, and the literature. Time Horizon. Lifetime. Interventions. CAD risk screening for high-risk individuals using Framingham risk equation and use of statins as the primary preventive measure, compared with a setting without screening. Outcome Measures. Life-years (LY) gained, quality-adjusted life-years (QALYs) gained. Results. The model-based CAD incidence corresponds well with empirical data from the MONICA Augsburg study. Health outcomes depend on the screening threshold (cutoff value of Framingham 10-year risk) and on the age and gender of the cohort screened (0.03 to 0.26 LYs and 0.06 to 0.42 QALYs gained per person screened in cohorts of 50- and 60-year-old men and women, respectively). Conclusions. The model provides a valid tool for evaluating the long-term effectiveness of CAD risk screening in Germany. Using statins as a primary prevention intervention for CAD in high-risk individuals identified by screening could improve the long-term health of the German population.
Andrawes WF, Bussy C., Belmin J.Prevention of cardiovascular events in elderly people. Drugs Aging. 2005;22(10):859-76.
2.
Hay JW, Sterling KLCost effectiveness of treating low HDL-cholesterol in the primary prevention of coronary heart disease. Pharmacoeconomics. 2005;23(2):133-41.
3.
Schmermund A. , Mohlenkamp S., Stang A., et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study . Risk Factors, Evaluation of Coronary Calcium and Lifestyle. Am Heart J. 2002;144(2):212-8.
4.
Schmermund A. , Lehmann N., Bielak LF, et al. Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America. Atherosclerosis. 2007;195(1):e207-16.
5.
Anderson KM, Wilson PW, Odell PM, Kannel WBAn updated coronary risk profile: a statement for health professionals . Circulation. 1991;83(1):356-62.
6.
Vrecer M., Turk S., Drinovec J., Mrhar A.Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke: meta-analysis of randomized trials. Int J Clin Pharmacol Ther. 2003;41(12):567-77.
7.
Kuntz K., Weinstein M.Modelling in economic evaluation. In: Drummond MF, McGuire A, eds. Economic Evaluation in Health Care. Oxford (UK): Oxford University Press;2001.
8.
Stolzenberg H.Bundes-Gesundheitssurvey 1998: Public use file BGS98. Berlin: Robert Koch Institut ; 2000.
9.
Lauterbach KW , Wille E., Lüngen M., et al. Modell eines fairen Wettbewerbs durch den Risikostrukturausgleich. Institut für Gesundheitsökonomie und klinische Epidemiologie (IGKE) der Universität zu Köln und Lehrstuhl für Volkswirtschaftslehre der Universität Mannheim, Köln, Mannheim . Gutachten im Auftrag des Verbandes der Angestellten-Krankenkassen e. V. (VdAK), des Arbeiter-Ersatzkassen-Verbandes e. V. (AEV), dem AOK-Bundesverband (AOK-BV) und dem IKK-Budnesverband (IKK-BV); 2001.
10.
Wood SNGeneralized Additive Models: An Introduction with R. London : Chapman & Hall/CRC; 2006 .
11.
Rosengren A. , Wilhelmsen L., Hagman M., Wedel H.Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Goteborg, Sweden. J Intern Med. 1998;244(6):495-505.
12.
Bates DM, Watts DGNonlinear Regression Analysis and Its Applications. New York: John Wiley & Sons; 1988 .
13.
Stollenwerk B. , Siebert U.Modeling joint cause-specific mortality in decision-analytic screening models. Presented at the Society for Medical Decision Making Europe; Engelberg , Switzerland; 2008.
14.
Daviglus ML , Stamler J., Pirzada A., et al. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality . JAMA. 2004;292(13):1588-92.
15.
Lowe LP, Greenland P., Ruth KJ, Dyer AR, Stamler R., Stamler J.Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men. Arch Intern Med. 1998;158(18):2007-14.
16.
Rosengren A. , Dotevall A., Eriksson H., Wilhelmsen L.Optimal risk factors in the population: prognosis, prevalence, and secular trends; data from Goteborg population studies. Eur Heart J. 2001; 22(2):136-44.
17.
Stamler J., Stamler R., Neaton JD, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999;282(21):2012-8.
18.
Lauterbach KW , Gerber A., Stollenwerk B., Wendland G., Klever-Deichert G.Die Bedeutung der Therapie mit Lipidsenkern für die kardiovaskuläre Prävention aus gesundheitsökonomischer Sicht. In: Bundesärztekammer, ed. Fortschritt und Fortbildung in der Medizin. Köln (Germany): Deutscher Ärzte Verlag; 2005. p 236-44.
19.
Hayashino Y. , Nagata-Kobayashi S., Morimoto T., Maeda K., Shimbo T., Fukui T.Cost-effectiveness of screening for coronary artery disease in asymptomatic patients with type 2 diabetes and additional atherogenic risk factors. J Gen Intern Med. 2004; 19(12):1181-91.
20.
Monagan MB, Geddes KO, Heal KM, et al. Maple 9: Introductory Programming Guide. Waterloo, Canada: Maplesoft; 2003 .
21.
Doubilet P. , Begg CB, Weinstein MC, Braun P., McNeil BJProbabilistic sensitivity analysis using Monte Carlo simulation: a practical approach. Med Decis Making.1985;5(2):157-77.
22.
Hense HW, Schulte H., Lowel H., Assmann G., Keil U.Framingham risk function overestimates risk of coronary heart disease in men and women from Germany-results from the MONICA Augsburg and the PROCAM cohorts . Eur Heart J. 2003;24(10):937-45.
23.
Tunstall-Pedoe H., Kuulasmaa K., Amouyel P., Arveiler D., Rajakangas AM, Pajak A.Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90(1): 583-612.
24.
Clopper C., Pearson S.The use of confidence or fiducial limits illustrated in the case of the binomial . Biometrika. 1934;26(4): 404-13.
25.
Hayashino Y. , Shimbo T., Tsujii S., et al. Cost-effectiveness of coronary artery disease screening in asymptomatic patients with type 2 diabetes and other atherogenic risk factors in Japan: factors influencing on international application of evidence-based guidelines. Int J Cardiol. 2007;118(1):88-96.
26.
Sox HC Jr. , Littenberg B., Garber AMThe role of exercise testing in screening for coronary artery disease. Ann Intern Med. 1989;110(6):456-69.
27.
O’Malley PG, Greenberg BA, Taylor AJCost-effectiveness of using electron beam computed tomography to identify patients at risk for clinical coronary artery disease. Am Heart J.2004;148(1): 106-13.
28.
Lange AP, Szucs TD[Cost-effectiveness of atorvastatin in the early treatment of acute coronary syndromes in Germany based on the MIRACL study]. Med Klin (Munich). 2004;99(9):500-5.
29.
Szucs TD, Klose G., Dusing R.[Cost-effectiveness of atorvastatin for the prevention of coronary disease An analysis of the ASCOT study]. Dtsch Med Wochenschr . 2004;129(25-26):1420-4.
30.
Weinstein MC , Coxson PG, Williams LW, Pass TM, Stason WB, Goldman L.Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model. Am J Public Health. 1987;77(11):1417-26.
31.
Ward S., Lloyd Jones M., Pandor A., et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess.2007;11(14):1-178.
32.
Greving JP, Buskens E., Koffijberg H., Algra A.Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation. 2008;117(22):2875-83.
33.
Baigent C., Keech A., Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267-78.
34.
Gelosa P., Cimino M., Pignieri A., Tremoli E., Guerrini U., Sironi L.The role of HMG-CoA reductase inhibition in endothelial dysfunction and inflammation . Vasc Health Risk Manag. 2007;3(5): 567-77.
35.
Ridker PMHigh-sensitivity C-reactive protein and cardiovascular risk: rationale for screening and primary prevention. Am J Cardiol. 2003;92(4B):17K-22K.
36.
Sever PSLipid-lowering therapy and the patient with multiple risk factors: what have we learned from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)?Am J Med. 2005;118(12A):3S-9S.
37.
Herpertz-Dahlmann B., Geller F., Bohle C., et al. Secular trends in body mass index measurements in preschool children from the City of Aachen, Germany. Eur J Pediatr. 2003;162(2):104-9.
38.
Kalies H., Lenz J., von Kries R.Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997. Int J Obes Relat Metab Disord . 2002;26(9):1211-7. 39. Complications and side effects. Health Canada warns about statin side effects. TreatmentUpdate. 2005;17(4):7.
39.
Paiva H., Thelen KM, Van Coster R., et al. High-dose statins and skeletal muscle metabolism in humans: a randomized, controlled trial. Clin Pharmacol Ther. 2005;78(1):60-8.
