Simulating the impact of improved cardiovascular risk interventions on clinical and economic outcomes in Russia

PLoS One. 2014 Aug 20;9(8):e103280. doi: 10.1371/journal.pone.0103280. eCollection 2014.

Abstract

Objectives: Russia faces a high burden of cardiovascular disease. Prevalence of all cardiovascular risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment programs aimed at increasing blood pressure control would affect cardiovascular outcomes. In addition, we investigated what additional benefit adding lipid control and smoking cessation to blood pressure control would generate in terms of reduced cardiovascular events. Finally, we estimated the direct health care costs saved by treating fewer cardiovascular events.

Methods: The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure <140 mmHg) of 40% and 60% were simulated by modifying adherence rates of an antihypertensive medication combination and compared with current care (23.9% blood pressure control rate). Outcomes of major adverse cardiovascular events; cerebrovascular event (stroke), myocardial infarction, and cardiovascular death over a 10-year time horizon were reported. Direct health care costs of strokes and myocardial infarctions were derived from official Russian statistics and tariff lists.

Results: To achieve systolic blood pressure control rates of 40% and 60%, adherence rates to the antihypertensive treatment program were 29.4% and 65.9%. Cardiovascular death relative risk reductions were 13.2%, and 29.6%, respectively. For the current estimated 43,855,000-person Russian hypertensive population, each control-rate scenario resulted in an absolute reduction of 1.0 million and 2.4 million cardiovascular deaths, and a reduction of 1.2 million and 2.7 million stroke/myocardial infarction diagnoses, respectively. Averted direct costs from current care levels ($7.6 billion [in United States dollars]) were $1.1 billion and $2.6 billion, respectively.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / economics
  • Antihypertensive Agents / therapeutic use*
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control*
  • Cost-Benefit Analysis
  • Health Care Costs*
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / economics
  • Hypertension / physiopathology
  • Medication Adherence*
  • Models, Economic
  • Models, Theoretical
  • Risk Factors
  • Russia

Substances

  • Antihypertensive Agents

Grants and funding

The work was funded by Novartis Pharma, Basel, Switzerland. The company played a role in this study due to the employment of two authors of this study in subsidiary Novartis companies (these authors were involved in the study concept and initial design, literature review, input into modeling parameters, interpretation of data analysis and assistance with manuscript writing). However, final decisions on content and the decision to publish were the responsibility of the non-Novartis authors.