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Effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population: A decision-analytic Markov model / 北京大学学报(医学版)
Journal of Peking University(Health Sciences) ; (6): 460-466, 2021.
Article in Chinese | WPRIM | ID: wpr-942202
ABSTRACT
OBJECTIVE@#To evaluate the potential effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population from economically developed area of China.@*METHODS@#Totally 202 179 adults aged 40 to 74 years without cardiovascular diseases at baseline (January 1, 2010) were enrolled from the Chinese electronic health records research in Yinzhou (CHERRY) study. Three scenarios were considered the screening strategy based on risk charts recommended by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases in Chinese adults aged 40-74 years (Strategy 1); the screening strategy based on the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) models recommended by the 2019 Guideline on the assessment and management of cardiovascular risk in China in Chinese adults aged 40-74 years (Strategy 2); and the screening strategy based on the China-PAR models in Chinese adults aged 50-74 years (Strategy 3). According to the guidelines, individuals who were classified into medium- or high-risk groups after cardiovascular risk assessment by the corresponding strategies would be introduced to lifestyle intervention, while high-risk population would take medication in addition. Markov model was used to simulate different screening scenarios for 10 years (cycles), using parameters mainly from the CHERRY study, as well as published data, Meta-analyses and systematic reviews for Chinese populations. The life year gained, quality-adjusted life year (QALY) gained, number of cardiovascular disease events/deaths could be prevented and number needed to be screened (NNS) were calculated to compare the effectiveness between the different strategies. One-way sensitivity analysis on uncertainty of cardiovascular disease incidence rate and probabilistic sensitivity analysis on uncertainty of distributions for the hazard ratios were conducted.@*RESULTS@#Compared with non-screening strategy, QALYs gained were 1 433 [95% uncertainty interval (UI) 969-1 831], 1 401 (95%UI 936-1 807), and 716 (95%UI 265-1 111) for the Strategies 1, 2, and 3; and the NNS per QALY in the above strategies were 141 (95%UI 110-209), 144 (95%UI 112-216), and 198 (95%UI 127-529), respectively. The Strategies 1 and 2 based on different guidelines showed similar effectiveness, while more benefits were found for screening using China-PAR models in adults aged 40-74 years than those aged 50-74 years. The results were consistent in the sensitivity analyses.@*CONCLUSION@#Screening for cardiovascular diseases in Chinese adults aged above 40 years seems effective in coastal developed areas of China, and the different screening strategies based on risk charts by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases or China-PAR models by the 2019 Guideline on the assessment and management of cardiovascular risk in China may have similar effectiveness.
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Full text: Available Index: WPRIM (Western Pacific) Main subject: Primary Prevention / Cardiovascular Diseases / China / Mass Screening / Cost-Benefit Analysis / Quality-Adjusted Life Years Type of study: Diagnostic study / Health economic evaluation / Prognostic study / Screening study Limits: Adult / Humans Country/Region as subject: Asia Language: Chinese Journal: Journal of Peking University(Health Sciences) Year: 2021 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Primary Prevention / Cardiovascular Diseases / China / Mass Screening / Cost-Benefit Analysis / Quality-Adjusted Life Years Type of study: Diagnostic study / Health economic evaluation / Prognostic study / Screening study Limits: Adult / Humans Country/Region as subject: Asia Language: Chinese Journal: Journal of Peking University(Health Sciences) Year: 2021 Type: Article