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High Risk versus Proportional Benefit: Modelling Equitable Strategies in Cardiovascular Prevention.

Marchant I, Boissel JP, Nony P, Gueyffier F - PLoS ONE (2015)

Bottom Line: The redistribution of benefits improved the profile of residual events in younger individuals compared to the 2007 ESH/ESC guidelines.The Proportional Benefit strategy provides the first response ever proposed against the inequity of resource use when treating highest risk people.Our approach allows adapting recommendations to the risk and resources of a particular country.

View Article: PubMed Central - PubMed

Affiliation: Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile.

ABSTRACT

Objective: To examine the performances of an alternative strategy to decide initiating BP-lowering drugs called Proportional Benefit (PB). It selects candidates addressing the inequity induced by the high-risk approach since it distributes the gains proportionally to the burden of disease by genders and ages.

Study design and setting: Mild hypertensives from a Realistic Virtual Population by genders and 10-year age classes (range 35-64 years) received simulated treatment over 10 years according to the PB strategy or the 2007 ESH/ESC guidelines (ESH/ESC). Primary outcomes were the relative life-year gain (life-years gained-to-years of potential life lost ratio) and the number needed to treat to gain a life-year. A sensitivity analysis was performed to assess the impact of changes introduced by the ESH/ESC guidelines appeared in 2013 on these outcomes.

Results: The 2007 ESH/ESC relative life-year gains by ages were 2%; 10%; 14% in men, and 0%; 2%; 11% in women, this gradient being abolished by the PB (relative gain in all categories = 10%), while preserving the same overall gain in life-years. The redistribution of benefits improved the profile of residual events in younger individuals compared to the 2007 ESH/ESC guidelines. The PB strategy was more efficient (NNT = 131) than the 2013 ESH/ESC guidelines, whatever the level of evidence of the scenario adopted (NNT = 139 and NNT = 179 with the evidence-based scenario and the opinion-based scenario, respectively), although the 2007 ESH/ESC guidelines remained the most efficient strategy (NNT = 114).

Conclusion: The Proportional Benefit strategy provides the first response ever proposed against the inequity of resource use when treating highest risk people. It occupies an intermediate position with regards to the efficiency expected from the application of historical and current ESH/ESC hypertension guidelines. Our approach allows adapting recommendations to the risk and resources of a particular country.

No MeSH data available.


Related in: MedlinePlus

Simulation steps to design the proportional benefit strategy to identify the treatment target population.The reference is the overall Proportional Benefit, i.e. the relative life-year gain obtained from the application of the 2007 ESH/ESC recommendation on the potentially eligible individuals from the Realistic Virtual French Population. Abbreviations: PB, proportional benefit; YPLL, years of potential life lost; LYG, life-years gained; NEP, number of events prevented; NNT, number needed to treat to gain a life-year.
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pone.0140793.g002: Simulation steps to design the proportional benefit strategy to identify the treatment target population.The reference is the overall Proportional Benefit, i.e. the relative life-year gain obtained from the application of the 2007 ESH/ESC recommendation on the potentially eligible individuals from the Realistic Virtual French Population. Abbreviations: PB, proportional benefit; YPLL, years of potential life lost; LYG, life-years gained; NEP, number of events prevented; NNT, number needed to treat to gain a life-year.

Mentions: The function that simulates the exposure to treatment (Fig 1) was used to find the risk percentile that allows achieving the benefit desired NEPdes within each category of individuals potentially eligible. We tested by iteration an increasing risk percentile into the function until the NEP obtained was equal to the NEP desired (Fig 2). The resulting Proportional Benefit strategy thus recognizes the individuals to treat from the new CVD risk thresholds adjusted by ages and genders. In our example, these thresholds corresponded to percentiles 65, 63 and 61 in the first, second and third age category of virtual male.


High Risk versus Proportional Benefit: Modelling Equitable Strategies in Cardiovascular Prevention.

Marchant I, Boissel JP, Nony P, Gueyffier F - PLoS ONE (2015)

Simulation steps to design the proportional benefit strategy to identify the treatment target population.The reference is the overall Proportional Benefit, i.e. the relative life-year gain obtained from the application of the 2007 ESH/ESC recommendation on the potentially eligible individuals from the Realistic Virtual French Population. Abbreviations: PB, proportional benefit; YPLL, years of potential life lost; LYG, life-years gained; NEP, number of events prevented; NNT, number needed to treat to gain a life-year.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4631497&req=5

pone.0140793.g002: Simulation steps to design the proportional benefit strategy to identify the treatment target population.The reference is the overall Proportional Benefit, i.e. the relative life-year gain obtained from the application of the 2007 ESH/ESC recommendation on the potentially eligible individuals from the Realistic Virtual French Population. Abbreviations: PB, proportional benefit; YPLL, years of potential life lost; LYG, life-years gained; NEP, number of events prevented; NNT, number needed to treat to gain a life-year.
Mentions: The function that simulates the exposure to treatment (Fig 1) was used to find the risk percentile that allows achieving the benefit desired NEPdes within each category of individuals potentially eligible. We tested by iteration an increasing risk percentile into the function until the NEP obtained was equal to the NEP desired (Fig 2). The resulting Proportional Benefit strategy thus recognizes the individuals to treat from the new CVD risk thresholds adjusted by ages and genders. In our example, these thresholds corresponded to percentiles 65, 63 and 61 in the first, second and third age category of virtual male.

Bottom Line: The redistribution of benefits improved the profile of residual events in younger individuals compared to the 2007 ESH/ESC guidelines.The Proportional Benefit strategy provides the first response ever proposed against the inequity of resource use when treating highest risk people.Our approach allows adapting recommendations to the risk and resources of a particular country.

View Article: PubMed Central - PubMed

Affiliation: Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile.

ABSTRACT

Objective: To examine the performances of an alternative strategy to decide initiating BP-lowering drugs called Proportional Benefit (PB). It selects candidates addressing the inequity induced by the high-risk approach since it distributes the gains proportionally to the burden of disease by genders and ages.

Study design and setting: Mild hypertensives from a Realistic Virtual Population by genders and 10-year age classes (range 35-64 years) received simulated treatment over 10 years according to the PB strategy or the 2007 ESH/ESC guidelines (ESH/ESC). Primary outcomes were the relative life-year gain (life-years gained-to-years of potential life lost ratio) and the number needed to treat to gain a life-year. A sensitivity analysis was performed to assess the impact of changes introduced by the ESH/ESC guidelines appeared in 2013 on these outcomes.

Results: The 2007 ESH/ESC relative life-year gains by ages were 2%; 10%; 14% in men, and 0%; 2%; 11% in women, this gradient being abolished by the PB (relative gain in all categories = 10%), while preserving the same overall gain in life-years. The redistribution of benefits improved the profile of residual events in younger individuals compared to the 2007 ESH/ESC guidelines. The PB strategy was more efficient (NNT = 131) than the 2013 ESH/ESC guidelines, whatever the level of evidence of the scenario adopted (NNT = 139 and NNT = 179 with the evidence-based scenario and the opinion-based scenario, respectively), although the 2007 ESH/ESC guidelines remained the most efficient strategy (NNT = 114).

Conclusion: The Proportional Benefit strategy provides the first response ever proposed against the inequity of resource use when treating highest risk people. It occupies an intermediate position with regards to the efficiency expected from the application of historical and current ESH/ESC hypertension guidelines. Our approach allows adapting recommendations to the risk and resources of a particular country.

No MeSH data available.


Related in: MedlinePlus