The Scottish cardiovascular disease policy model

R Medicine (General);RA Public aspects of medicine

Lawson, Kenneth Daniel ; Briggs, Andrew H.

University:University of Glasgow

Department:Institute of Health and Wellbeing

关键词: Cardiovascular disease, primary prevention, health economics, cost effectiveness, policy, model;   

Others  :  http://theses.gla.ac.uk/4695/1/2013lawsonphd.pdf

来源: University of Glasgow

【 摘 要 】

This thesis is concerned with economic evaluation in the primary prevention of cardiovascular disease. Policymakers are increasingly focussed on reducing the health and economic burden of CVD and to reduce health inequalities. However, the approach to primary prevention suffers from fundamental weaknesses that this research intends to help address.There is general lack of effectiveness and cost effectiveness evidence underpinning current primary prevention interventions. First, there is a policy impetus towards mass screening strategies to target individuals at high risk of developing CVD when more focussed approaches may be more cost effective. Second, clinicians prioritise individuals on the basis of 10-year risk scores, which are strongly driven by age, and not the potential benefits (or costs) from treatment. Third, targeted and population interventions are often still treated as competing approaches, whereas the key issue is how they might best combine.The key premise of this thesis is that the aims of primary prevention are the avoidance of premature morbidity, mortality and to close health inequalities - subject to a budget constraint. A CVD Policy Model was created using the same nine risk factors as used in the ASSIGN 10-year risk score, currently used in clinical practice in Scotland, to estimate life expectancy, quality adjusted life expectancy and lifetime hospital costs. This model can be employed to estimate the cost effectiveness of interventions and the impact on health inequalities. The model performed well in a comprehensive validation process in terms of face validity, internal validity, and external validity. Life expectancy predictions were re-calibrated to contemporary lifetables. This generic modelling approach (i.e. using a wide range of inputs and producing a wide range of outputs) is intended to avoid the need to build bespoke models for different interventions aimed at particular risk factors or to produce particular outputs.In application, the CVD Policy Model is intended to assist clinicians and policymakers to develop a more coherent approach to primary prevention, namely: to design more efficient screening strategies; prioritise individuals for intervention on the basis of potential benefit (rather than risk); and to assess the impact of both individually targeted and population interventions on a consistent basis. Using the model in these ways may enable primary prevention approaches to be more consistent with guidelines from health sector reimbursement agencies, which may result in a more efficient use of scarce resources.