Background
Methods
Study population
Overall cardiovascular risk
Framingham risk definitions
Statistical analyses
Simulated screening strategies
Effectiveness
Impact
-
N = number of high-risk people in respective screening strategy
-
Cardiovascular disease rate = average FRS score for respective screening strategy
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pd = proportion of high-risk people with disease/ risk factor requiring intervention
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pu = proportion of high-risk people with disease/ risk factor requiring intervention that take up the intervention
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pc = proportion of adequacy of control /adherence to intervention
Sensitivity analyses
Therapy/ Intervention | Percentage of uptake * | Percentage of adherence* | RRR ‡ |
---|---|---|---|
Antihypertensives | 87.5 | 26.3 | 0.22 |
Lipid lowering drugs | 44.1 | 69 | 0.22 |
Hypoglycaemic agents | 85.8 | 29.3† | 0.1 |
Smoking cessation | 70.6 | 9.30 | 0.36 |
Sensitivity analyses
| |||
Antihypertensives | 57.5 | 24.8 | 0.17 |
Lipid lowering drugs | 14.1 | 65.3 | 0.18 |
Hypoglycaemic agents | 55.8 | 17.1 | 0.02 |
Smoking cessation | 40.6 | 8.9 | 0.29 |
Cost
Assumptions
Results
Distribution of overall cardiovascular risk
Overall | Low risk | Intermediate risk | High risk | p value | |
---|---|---|---|---|---|
Variables
| |||||
Age | 49.4 (0.01) | 48.4 (0.03) | 49.7 (0.03) | 52.9 (0.13) | |
Male sex | 49.6 | 40 | 55 | 64.3 | <0.001 |
Race | 0.008 | ||||
Malay | 48.4 | 47.2 | 48.3 | 50.9 | |
Chinese | 29.6 | 28.3 | 30.3 | 31.5 | |
Asian Indian | 7.8 | 7.9 | 8.2 | 7.4 | |
Others | 14.2 | 16.6 | 13.2 | 10.1 | |
Residence | 0.007 | ||||
Urban | 60.8 | 64.3 | 58 | 55.8 | |
Rural | 39.2 | 35.7 | 42 | 44.2 | |
Education (Years of schooling) | <0.001 | ||||
Tertiary (≥ 13 years) | 7.8 | 11.1 | 5.8 | 2.8 | |
Secondary (7–12 years) | 41.7 | 54.3 | 33.7 | 22.9 | |
Primary (≤6 years) | 35.4 | 26.4 | 40.9 | 49 | |
Household income | <0.001 | ||||
<RM2000 | 62.4 | 57.1 | 64.4 | 71.4 | |
RM2000-3999 | 23.9 | 26.3 | 23.1 | 19.8 | |
≥RM4000 | 13.7 | 16.6 | 12.5 | 8.8 | |
Prevalences of CV risk factors | |||||
Smoking | 22.2 (20.3, 24.3) | 16.6 (14.8, 18.5) | 25.9 (23.8, 28.0) | 30.7 (27.7, 33.8) | <0.001 |
Central obesity | 44.6 (42.6, 46.5) | 38.4 (36.7, 40.2) | 48.5 (45, 51.9) | 53.8 (51, 56.5) | <0.001 |
Hypertension | 50.1 (48.1, 52.2) | 26.1 (24.4, 28.1) | 64.3 (62.2, 66.5) | 87 (85.9, 88) | <0.001 |
Hypercholesterolemia | 30.3 (27.7, 33) | 23.2 (21.0, 25.5) | 35.9 (32.6, 39.3) | 40.1 (36.8, 43.6) | <0.001 |
Diabetes | 15.2 (13.8, 16.7) | 4 (3.4, 4.6) | 15.4 (13.7, 17.3) | 37.3 (33.7, 41) | <0.001 |
Coverage and detection of populations at high cardiovascular risk
Targeted screening | Universal | ||||
---|---|---|---|---|---|
≥ age 50 | ≥ age 45 | ≥ age 40 | ≥ age 35 | screening | |
Overall
| |||||
Coverage of population | 46.72 | 58.06 | 70.13 | 84.47 | 100.00 |
Coverage of high risk population | 94.39 | 98.71 | 99.82 | 100.00 | 100.00 |
% of high risk individuals - among those screened | 53.97 | 45.42 | 38.02 | 31.62 | 26.71 |
NNS to detect 1 high risk individual (no.) | 1.85 | 2.20 | 2.63 | 3.16 | 3.74 |
Males
| |||||
Coverage of population | 44.36 | 56.32 | 68.82 | 83.95 | 100.00 |
Coverage of high risk population | 92.60 | 98.22 | 99.75 | 100.00 | 100.00 |
% of high risk individuals - among those screened | 72.41 | 60.50 | 50.28 | 41.32 | 34.69 |
NNS to detect 1 high risk individual (no.) | 1.38 | 1.65 | 1.99 | 2.42 | 2.88 |
Females
| |||||
Coverage of population | 49.03 | 59.76 | 71.41 | 84.98 | 100.00 |
Coverage of high risk population | 97.61 | 99.58 | 99.99 | 100.00 | 100.00 |
% of high risk individuals - among those screened | 37.59 | 31.47 | 26.43 | 22.22 | 18.88 |
NNS to detect 1 high risk individual (no.) | 2.66 | 3.18 | 3.78 | 4.50 | 5.30 |
Effectiveness of screening strategies
Incremental effectiveness of screening strategies
Targeted screening | Universal | ||||
---|---|---|---|---|---|
≥ age 50† | ≥ age 45 | ≥ age 40 | ≥ age 35 | screening | |
Strategies implemented incrementally*
| |||||
Additional % of population screened | - | 24.27 | 20.79 | 20.45 | 18.39 |
Additional coverage of high risk population screened | - | 4.32 | 1.11 | 0.18 | 0.00 |
% of additional high risk individuals detected | - | 4.59 | 1.11 | 0.17 | 0.01 |
Additional NNS to detect 1 high risk individual | - | 9.81 | 41.20 | 309.67 | 7168.90 |
Males
| |||||
Additional % of population screened | - | 26.96 | 22.20 | 21.99 | 19.12 |
Additional coverage of high risk population screened | - | 5.62 | 1.53 | 0.25 | 0.00 |
% of additional high risk individuals detected | - | 6.08 | 1.55 | 0.25 | 0.01 |
Additional NNS to detect 1 high risk individual | - | 6.12 | 23.61 | 176.52 | 5179.06 |
Females
| |||||
Additional % of population screened | - | 21.88 | 19.49 | 19.00 | 17.67 |
Additional coverage of high risk population screened | - | 1.97 | 0.41 | 0.01 | 0.00 |
% of additional high risk individuals detected | - | 2.04 | 0.36 | 0.05 | 0.01 |
Additional NNS to detect 1 high risk individual | - | 28.53 | 173.39 | 1525.92 | 5876.37 |
Impact
Targeted screening | Universal | ||||
---|---|---|---|---|---|
≥ age 50† | ≥ age 45 | ≥ age 40 | ≥ age 35 | screening | |
Overall
| |||||
Estimated cost to detect 1 high risk individual, MYR (USD) | 92.64 (29.73) | 110.08 (35.33) | 131.51 (42.20) | 158.13 (50.75) | 187.2 (60.08) |
Incremental cost per additional high risk individual detected, MYR | - | 490.27 | 2060.12 | 15483.29 | 358444.85 |
(USD) | - | (157.34) | (661.14) | (4968.96) | (115033.65) |
NNS to prevent one CV event | 62.24 | 76.14 | 96.64 | 123.95 | 146.73 |
NNS to prevent one CV event (sensitivity analyses) | 168.47 | 206.07 | 261.57 | 335.48 | 397.15 |
Males
| |||||
Estimated cost to detect 1 high risk individual, MYR (USD) | 69.05 (22.16) | 82.64 (26.52) | 99.44 (31.91) | 121.01 (38.84) | 144.13 (46.25) |
Incremental cost per additional high risk individual detected, MYR | - | 306.21 | 1180.58 | 8825.99 | 258952.77 |
(USD) | - | (98.27) | (378.88) | (2832.47) | (83104.23) |
NNS to prevent one CV event | 45.33 | 57.27 | 72.96 | 94.33 | 112.36 |
NNS to prevent one CV event (sensitivity analyses) | 120.13 | 151.77 | 193.36 | 249.97 | 297.77 |
Females
| |||||
Estimated cost to detect 1 high risk individual, MYR (USD) | 133.01 (42.69) | 158.88 (50.99) | 189.18 (60.71) | 225.02 (72.21) | 264.83 (84.99) |
Incremental cost per additional high risk individual detected, MYR | - | 1426.50 | 8669.32 | 76295.96 | 293818.47 |
(USD) | - | (457.8) | (2782.19) | (24485.23) | (94293.47) |
NNS to prevent one CV event | 85.72 | 105.59 | 129.78 | 165.01 | 194.20 |
NNS to prevent one CV event (sensitivity analyses) | 240.97 | 394.25 | 364.83 | 463.95 | 545.95 |