Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

A. David Paltiel

Abstract

Background-- Cardiovascular disease (CVD) risk scores that require laboratory testing (e.g., cholesterol testing) are often used to identify high- and low-risk individuals for primary CVD prevention interventions, such as statin treatment. However, laboratory testing can be expensive and difficult to conduct in resource-limited settings. The aim of this study was to compare CVD risk characterization and evaluate the cost-effectiveness of non-laboratory based and laboratory-based CVD risk scores for adults in Tashkent City, Uzbekistan.

Methods--CVD risk for 853 adults (376 men, 477 women) from Tashkent City, Uzbekistan was assessed using laboratory-based and non-laboratory-based scores calculated from 2002 Uzbekistan Health Examination Survey (UHES) data. Non-laboratory-based risk predictions were compared to the six laboratory-based scores (SCORE for high-risk and low-risk countries, three versions of Framingham risk scores, and CUORE) using Spearman rank correlation. The agreement of risk characterization for men was also evaluated by calculating the proportion of the male population equivalently characterized as "high" or "low" risk using either type of score. Using the UHES data, model populations of 10,000 men and 10,000 women were generated and used for cost-effectiveness modeling. A micro-simulation model that projected lifetime CVD-associated costs and quality-adjusted life years (QALYs) was used to calculate incremental cost-effectiveness ratios (ICERs) for non-laboratory and SCORE (for high risk

countries) risk screening approaches.

Results - The Spearman rank correlation coefficients for the laboratory-based and non-laboratory-based CVD risk scores ranged from 0.872-0.984 for men and 0.937-0.980 for women. The ICERs for the non-laboratory-based strategies on the efficient frontier (nondominated strategies) ranged from $843 to $6,551 for men and $6,249 to $16,193 for women. Almost all SCORE strategies for both men and women were dominated (higher cost and lower QALYs); the only exception had an ICER of $91,799.

Conclusions - For both men and women, there was a high correlation between the laboratory-based and nonlaboratory-based risk assessment methods. In men, there was also a high level of agreement in risk characterization between the laboratory-based and non-laboratory-based risk scores. It is cost-effective to use the non laboratory based risk score to assess and then treat the top 1.60% of the male population who are at the highest risk for developing CVD (given a willingness to pay threshold of $5,150/QALY). No CVD screening is cost-effective for women in Uzbekistan.

Comments

This is an Open Access Thesis.

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