One-size-fits-all versus risk-category-based screening interval strategies for cardiovascular disease prevention in Chinese adults: a prospective cohort study

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-07-16 DOI:10.1016/j.lanwpc.2024.101140
Zhijia Sun , Yu Ma , Canqing Yu , Dianjianyi Sun , Yuanjie Pang , Pei Pei , Ling Yang , Yiping Chen , Huaidong Du , Hao Zhang , Xiaoming Yang , Maxim Barnard , Robert Clarke , Junshi Chen , Zhengming Chen , Liming Li , Jun Lv
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Abstract

Background

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.

Methods

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.

Findings

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.

Interpretation

For the primary prevention of ASCVD, risk-category-based screening protocols outperformed the one-size-fits-all approach in the Chinese population.

Funding

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).

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中国成年人预防心血管疾病的 "一刀切 "与基于风险类别的筛查间隔策略:一项前瞻性队列研究
背景在非高风险人群中,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,由于缺乏研究证据,目前的决策受到了限制。我们的目的是探索在中国人群的 ASCVD 一级预防中,针对非高风险人群的基于风险类别的适当筛查间隔策略。方法我们使用了中国嘉道理生物库(CKB)中至少完成过两次实地调查的 28624 名参与者的数据。风险评估工具是基于 CKB 队列开发的 10 年 ASCVD 风险预测模型。我们构建了多态马尔可夫模型来模拟疾病进展,并估算不同风险类别之间的转换概率。我们计算了每个筛查间隔方案在 10 年内处于高风险状态而未被发现的总人年数。我们还估算了与每 3 年一次的筛查方案相比,所预防的 ASCVD 事件的数量、所获得的质量调整生命年 (QALY) 以及所节约的成本。研究结果与每 3 年一次的统一方案相比,大多数基于风险类别的筛查间隔方案都能及时发现更多的高危人群,从而预防更多的 ASCVD 事件并获得 QALY。其中少数方案还能降低医疗总成本。对低风险、中低风险和中高风险人群分别采用6年、3年和2年筛查间隔的方案是最佳方案,可将未识别为高风险类别的人年减少17.9%(95% CI:13.1%-21.9%),从而在10年内为30-79岁的中国成年人预防约11.3万例(95% CI:83-138)严重ASCVD事件。在使用他汀类药物治疗成本较低的情况下,更多的筛查方案将在节约成本的同时获得QALYs.Interpretation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。CKB 基线调查和首次复查得到了香港嘉道理慈善基金会的资助。长期跟踪研究得到了英国威康信托基金(212946/Z/18/Z、202922/Z/16/Z、104085/Z/14/Z、088158/Z/09/Z)、国家重点研发计划(2016YFC0900500)、国家自然科学基金(81390540、91846303、81941018)和中国科技部(2011BAI09B01)的资助。
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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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