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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

Age-related proportions of individuals to treat according to the PB strategy and the 2007 ESH/ESC guidelines.Pie areas indicate the relative contributions of age classes to the overall number of subjects eligible to treatment referred to the ineligible individuals of all ages.
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pone.0140793.g003: Age-related proportions of individuals to treat according to the PB strategy and the 2007 ESH/ESC guidelines.Pie areas indicate the relative contributions of age classes to the overall number of subjects eligible to treatment referred to the ineligible individuals of all ages.

Mentions: The 2007 ESH/ESC guidelines provided 13074 life-years gained (NEP = 883) over 129199 years of potential life lost among the individuals potentially eligible (n = 466655), with a global proportional benefit coefficient of 10% (Table 2). The PB strategy resulted in a gender- and age-related gradient of risk-decision thresholds, with the highest threshold among individuals younger than 45 years and the lowest threshold in individuals over 55 years. While the proportions eligible to treatment showed a strong gradient related to age for both genders under the ESH/ESC strategy, this pattern was importantly attenuated in men and women by the PB strategy, with increased rates of treatment eligibility among individuals less than 55 (Fig 3). This implied an overall greater proportion of treated-to-untreated individuals under the PB strategy compared with the ESH/ESC strategy (37% versus 32% of the individuals potentially eligible on treatment, respectively).


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

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

Age-related proportions of individuals to treat according to the PB strategy and the 2007 ESH/ESC guidelines.Pie areas indicate the relative contributions of age classes to the overall number of subjects eligible to treatment referred to the ineligible individuals of all ages.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0140793.g003: Age-related proportions of individuals to treat according to the PB strategy and the 2007 ESH/ESC guidelines.Pie areas indicate the relative contributions of age classes to the overall number of subjects eligible to treatment referred to the ineligible individuals of all ages.
Mentions: The 2007 ESH/ESC guidelines provided 13074 life-years gained (NEP = 883) over 129199 years of potential life lost among the individuals potentially eligible (n = 466655), with a global proportional benefit coefficient of 10% (Table 2). The PB strategy resulted in a gender- and age-related gradient of risk-decision thresholds, with the highest threshold among individuals younger than 45 years and the lowest threshold in individuals over 55 years. While the proportions eligible to treatment showed a strong gradient related to age for both genders under the ESH/ESC strategy, this pattern was importantly attenuated in men and women by the PB strategy, with increased rates of treatment eligibility among individuals less than 55 (Fig 3). This implied an overall greater proportion of treated-to-untreated individuals under the PB strategy compared with the ESH/ESC strategy (37% versus 32% of the individuals potentially eligible on treatment, respectively).

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