scholarly journals Cost-effectiveness of a statewide public health intervention to reduce cardiovascular disease risk

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren Smith ◽  
Adam Atherly ◽  
Jon Campbell ◽  
Nick Flattery ◽  
Stephanie Coronel ◽  
...  
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Public Health Intervention ◽  
Health Intervention

Abstract 014: Comparative Cost-Effectiveness of 10-Year Atherosclerotic Cardiovascular Disease Risk Equations Over 10 Years of Follow-up: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Gabriel S Tajeu ◽  
Ciaran Kohli-Lynch ◽  
Yiyi Zhang ◽  
Paul Muntner ◽  
Steven Shea ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Statin Treatment ◽  
Moderate Intensity ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ethnic Study ◽  
Policy Model ◽  
Ascvd Risk

Introduction: Uncertainty remains regarding the most efficient and cost-effective 10-year atherosclerotic cardiovascular disease (ASCVD) risk prediction tool for identifying moderate to high-risk patients for primary prevention statin treatment. Methods: We utilized the CVD Policy Model, a computer microsimulation model of ASCVD incidence, prevalence, mortality, and costs, to compare cost-effectiveness of statin treatment at varying 10-year predicted ASCVD risk thresholds for Framingham CVD (FRS-CVD), Reynolds Risk Score (RRS), and Pooled Cohorts Risk Equations over a 10-year time horizon in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Cost effectiveness was assessed at predicted 10-year risk ≥ 20.0%, 15.0%, 10.0%, 7.5%, 5.0%, and 2.5%. We restricted the simulation cohort to participants aged 50 to 74 years who were not taking statins at baseline (n = 2,871). Moderate intensity statin treatment effectiveness was parameterized in the model as a 29% low-density lipoprotein cholesterol reduction. Total cost comprised statins ($100/year), side effect costs, and ASCVD event costs. Disability from treatment side effects and ASCVD events were included. Results: Average FRS-CVD, RRS, and Pooled Cohorts 10-year predicted ASCVD risks were 18.8%, 11.3%, 12.2%, for men and 8.9%, 4.3%, 6.6%, for women, respectively. At the same predicted risk, FRS-CVD consistently selected the most patients for treatment, and RRS the fewest ( Figure ). Compared with no treatment, treating patients with RRS ≥ 20% was cost saving in men. Subsequent risk threshold strategies with incremental cost effectiveness <$75,000/quality-adjusted life-year (QALY) for men were: FRS-CVD ≥ 20% ($13,046), RRS ≥ 7.5% ($17,774), and RRS ≥ 5.0% ($19,891). For women, the non-dominated thresholds were: Pooled Cohorts ≥ 15% ($27,908) and Pooled Cohorts ≥ 7.5% ($72,377). Conclusions: At cost-effectiveness thresholds less than $75,000/QALY, RRS was the highest value tool for men while the Pooled Cohorts Risk Equations performed best for women.

scholarly journals Impact of preventive screening and lifestyle interventions in women with a history of preeclampsia: A micro-simulation study

2020 ◽  
Vol 27 (13) ◽  
pp. 1389-1399 ◽  
Author(s):  
GR Lagerweij ◽  
L Brouwers ◽  
GA De Wit ◽  
KGM Moons ◽  
L Benschop ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Lifestyle Interventions ◽  
Quality Adjusted Life Years ◽  
Preventive Screening ◽  
Life Years ◽  
History Of ◽  
Quality Adjusted Life

Background Preeclampsia is a female-specific risk factor for the development of future cardiovascular disease. Whether early preventive cardiovascular disease risk screenings combined with risk-based lifestyle interventions in women with previous preeclampsia are beneficial and cost-effective is unknown. Methods A micro-simulation model was developed to assess the life-long impact of preventive cardiovascular screening strategies initiated after women experienced preeclampsia during pregnancy. Screening was started at the age of 30 or 40 years and repeated every five years. Data (initial and follow-up) from women with a history of preeclampsia was used to calculate 10-year cardiovascular disease risk estimates according to Framingham Risk Score. An absolute risk threshold of 2% was evaluated for treatment selection, i.e. lifestyle interventions (e.g. increasing physical activity). Screening benefits were assessed in terms of costs and quality-adjusted-life-years, and incremental cost-effectiveness ratios compared with no screening. Results Expected health outcomes for no screening are 27.35 quality-adjusted-life-years and increase to 27.43 quality-adjusted-life-years (screening at 30 years with 2% threshold). The expected costs for no screening are €9426 and around €13,881 for screening at 30 years (for a 2% threshold). Preventive screening at 40 years with a 2% threshold has the most favourable incremental cost-effectiveness ratio, i.e. €34,996/quality-adjusted-life-year, compared with other screening scenarios and no screening. Conclusions Early cardiovascular disease risk screening followed by risk-based lifestyle interventions may lead to small long-term health benefits in women with a history of preeclampsia. However, the cost-effectiveness of a lifelong cardiovascular prevention programme starting early after preeclampsia with risk-based lifestyle advice alone is relatively unfavourable. A combination of risk-based lifestyle advice plus medical therapy may be more beneficial.

Cost Effectiveness of Vaccinating Food Service Workers against Hepatitis A Infection

2000 ◽  
Vol 63 (6) ◽  
pp. 768-774 ◽  
Author(s):  
R. JAKE JACOBS ◽  
STEVEN F. GROVER ◽  
ALLEN S. MEYERHOFF ◽  
THOMAS A. PAIVANAS
Keyword(s):  
Public Health ◽  
Cost Effectiveness ◽  
Hepatitis A ◽  
Public Health Intervention ◽  
Food Service ◽  
Health Intervention ◽  
Parameter Estimates ◽  
Work Loss ◽  
Service Workers ◽  
Food Service Workers

Foodborne transmission is an important means of hepatitis A infection that may be reduced through vaccination of food service workers (FSWs). Several states are considering actions to encourage or mandate FSW vaccination, but the cost effectiveness of such policies has not been assessed. We estimated the clinical and economic consequences of vaccinating FSWs from the 10 states with the highest reported rates of hepatitis A. A decision analytic model was used to predict the effects of vaccinating FSWs at age 20 years. It was assumed all FSWs would receive one dose of inactivated hepatitis A vaccine, and 50% would receive the second recommended dose. Parameter estimates were obtained from published reports and Centers for Disease Control and Prevention databases. The primary endpoint was cost per year of life saved (YOLS). Secondary endpoints were symptomatic infections, days of illness, deaths, and costs of hepatitis A treatment, public health intervention, and work loss. Each endpoint was considered separately for FSWs and patrons. We estimate vaccination of 100,000 FSWs would cost $8.1 million but reduce the costs of hepatitis A treatment, public health intervention, and work loss by $3.0 million, $2.3 million, and $3.1 million, respectively. Vaccination would prevent approximately 2,500 symptomatic infections, 93,000 days of illness, and 8 deaths. A vaccination policy would reduce societal costs while costing the health system $13,969 per YOLS, a ratio that exceeds generally accepted standards of cost effectiveness.

scholarly journals Training the Next Generation of Latino Health Researchers: A Multilevel, Transdisciplinary, Community-Engaged Approach

2016 ◽  
Vol 18 (4) ◽  
pp. 497-504
Author(s):  
Alice A. Kuo ◽  
Mienah Z. Sharif ◽  
Michael L. Prelip ◽  
Deborah C. Glik ◽  
Stephanie L. Albert ◽  
...  
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Health Disparities ◽  
Mexican American ◽  
Disease Risk ◽  
Minority Group ◽  
Cardiovascular Disease Risk ◽  
Development Program ◽  
The United States ◽  
Public Health Workforce

Reducing health disparities is a national public health priority. Latinos represent the largest racial/ethnic minority group in the United States and suffer disproportionately from poor health outcomes, including cardiovascular disease risk. Academic training programs are an opportunity for reducing health disparities, in part by increasing the diversity of the public health workforce and by incorporating training designed to develop a skill set to address health disparities. This article describes the Training and Career Development Program at the UCLA Center for Population Health and Health Disparities: a multilevel, transdisciplinary training program that uses a community-engaged approach to reduce cardiovascular disease risk in two urban Mexican American communities. Results suggest that this program is effective in enhancing the skill sets of traditionally underrepresented students to become health disparities researchers and practitioners.

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