■在非高风险个体中,基于风险类别的动脉粥样硬化性心血管疾病(ASCVD)筛查策略可能比一刀切的方法更具成本效益.然而,当前的决策受到缺乏研究证据的制约。我们旨在探索中国人群中ASCVD一级预防非高危人群的基于风险类别的筛查间隔策略。
■我们使用了来自中国嘉道理生物库(CKB)的28,624名参与者的数据,这些参与者至少完成了两次实地调查。风险评估工具是基于CKB队列开发的10年ASCVD风险预测模型。我们构建了多状态马尔可夫模型来模拟疾病进展并估计不同风险类别之间的转移概率。对于每个筛选间隔方案,计算了10年期间在高风险状态下未识别的总人数年。我们还估计了预防的ASCVD事件的数量,获得的质量调整生命年(QALYs),与三年一次的筛查方案相比,节省了成本。
■与统一的三年协议相比,大多数基于风险类别的筛查间隔方案将及时识别更多高风险个体,从而防止更多的ASCVD事件并获得QALY。其中一些将减少总的医疗保健费用。协议,使用了6年,3年,和2年的低风险筛查间隔,中低风险,和中等高危人群,是最优的,并将高风险类别中未识别的人年减少17.9%(95%CI:13.1%-21.9%),因此,在10年的时间内,30-79岁的中国成年人估计可预防113,000(95%CI:83-138)硬ASCVD事件。当使用较低成本的他汀类药物治疗时,更多的筛选方案将获得QALY,同时节省成本。
■对于ASCVD的一级预防,在中国人群中,基于风险类别的筛查方案优于一刀切的方法.
■这项工作得到了国家自然科学基金(82192904,82388102,82192900)和国家重点研发计划(2023YFC2509400)的资助。CKB基线调查和首次重新调查得到了香港嘉道理慈善基金会的资助。长期随访得到英国惠康信托基金(212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,088158/Z/09/Z),国家重点研发计划资助(2016YFC0900500),国家自然科学基金(81390540,91846303,81941018),和中国科技部(2011BAI09B01)。
UNASSIGNED: In non-high-risk individuals, risk-category-based atherosclerotic cardiovascular disease (ASCVD) screening strategies may be more cost-effective than one-size-fits-all approaches. However, current decisions are constrained by a lack of research evidence. We aimed to explore appropriate risk-category-based screening interval strategies for non-high-risk individuals in ASCVD primary prevention in the Chinese population.
UNASSIGNED: We used data from 28,624 participants in the
China Kadoorie Biobank (CKB) who had completed at least two field surveys. The risk assessment tools were the 10-year ASCVD risk prediction models developed based on the CKB cohort. We constructed multistate Markov models to model disease progression and estimate transition probabilities between different risk categories. The total person-years spent unidentified in the high-risk state over a 10-year period were calculated for each screening interval protocol. We also estimated the number of ASCVD events prevented, quality-adjusted life years (QALYs) gained, and costs saved when compared to the 3-yearly screening protocol.
UNASSIGNED: When compared to the uniform 3-yearly protocol, most risk-category-based screening interval protocols would identify more high-risk individuals timely, thus preventing more ASCVD events and gaining QALYs. A few of them would reduce total health-care costs. The protocol, which used 6-year, 3-year, and 2-year screening intervals for low-risk, intermediate-low-risk, and intermediate-high risk individuals, was optimal, and would reduce the person-years spent unidentified in the high-risk category by 17.9% (95% CI: 13.1%-21.9%), thus preventing an estimated 113 thousand (95% CI: 83-138) hard ASCVD events for Chinese adults aged 30-79 over a 10-year period. When using a lower cost of statin therapy, more screening protocols would gain QALYs while saving costs.
UNASSIGNED: For the primary prevention of ASCVD, risk-category-based screening protocols outperformed the one-size-fits-all approach in the Chinese population.
UNASSIGNED: This work was supported by National Natural Science Foundation of
China (82192904, 82388102, 82192900) and grants (2023YFC2509400) from the National Key R&D Program of
China. The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z), grants (2016YFC0900500) from the National Key R&D Program of
China, National Natural Science Foundation of
China (81390540, 91846303, 81941018), and Chinese Ministry of Science and Technology (2011BAI09B01).