Key result
Selecting individuals for preventive treatment based on expected CVD burden rather than a 10% 10-year risk threshold resulted in an estimated gain of 217 quality-adjusted life years.
Why the study?
Does selecting individuals for CVD prevention based on expected lifelong burden rather than 10-year risk improve quality-adjusted life years?
Cohort (n=47,469)
Yes
Does selecting individuals for CVD prevention based on expected lifelong burden rather than 10-year risk improve quality-adjusted life years?
Effect estimate: 217 QALYs gained
Selecting individuals for CVD prevention based on expected lifelong burden rather than 10-year risk targets more younger individuals and increases overall quality-adjusted life years gained.
May support burden-based selection for CVD prevention; leaves open confirmation in prospective trials.
Background Cardiovascular disease (CVD) prevention is commonly focused on providing individuals at high predicted CVD risk with preventive medication. Whereas CVD risk increases rapidly with age, current risk-based selection of individuals mainly targets the elderly. However, the lifelong (preventable) consequences of CVD events may be larger in younger individuals. The purpose of this paper is to investigate if health benefits from preventive treatment may increase when the selection strategy is further optimised. Methods Data from three Dutch cohorts were combined ( n = 47469, men:women 1:1.92) and classified into subgroups based on age and gender. The Framingham global risk score was used to estimate 10-year CVD risk. The associated lifelong burden of CVD events according to this 10-year CVD risk was expressed as quality-adjusted life years lost. Based on this approach, the additional health benefits from preventive treatment, reducing this 10-year CVD risk, from selecting individuals based on their expected CVD burden rather than their expected CVD risk were estimated. These benefits were expressed as quality-adjusted life years gained over lifetime. Results When using the current selection strategy (10% risk threshold), 32% of the individuals were selected for preventive treatment. When the same proportion was selected based on burden, more younger and fewer older individuals would receive treatment. Across all individuals, the gain in quality-adjusted life years was 217 between the two strategies, over a 10-year time horizon. In addition, when combining the strategies 5% extra eligible individuals were selected resulting in a gain of 628 quality-adjusted life years. Conclusion Improvement of the selection approach of individuals can help to reduce further the CVD burden. Selecting individuals for preventive treatment based on their expected CVD burden will provide more younger and fewer older individuals with treatment, and will reduce the overall CVD burden.
No takes yet. Share an insight, caveat, or question.
Lagerweij et al. (2018) conducted a cohort in Cardiovascular disease prevention (n=47,469). Selection based on expected CVD burden vs. Current selection strategy (10% 10-year CVD risk threshold) was evaluated on Quality-adjusted life years (QALYs) gained (217 QALYs gained). Selecting individuals for preventive treatment based on expected CVD burden rather than a 10% 10-year risk threshold resulted in an estimated gain of 217 quality-adjusted life years.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: