Key Model Parameters
| Parameter | Value | Sensitivity Rangea | Source |
|---|---|---|---|
| Aspirin for primary prevention of CVD and colorectal cancer | |||
| Colorectal cancer incidence >10 y, RR | 0.60 | 0.76/0.47 | Chubak27,28 |
| Cardiovascular disease death, RR | 1.00 | 1.00/0.97 | Guirguis-Blake29,30 |
| Gastrointestinal bleed, RR | 1.58 | 1.95/1.29 | Whitlock31,32 |
| Hemorrhagic stroke, RR | 1.27 | 1.68/1.00 | Whitlock31,32 |
| Ischemic stroke, nonfatal, RR | 0.86 | 0.98/0.76 | Guirguis-Blake29,30 |
| Myocardial infarction, nonfatal, RR | 0.83 | 0.94/0.74 | Guirguis-Blake29,30 |
| Cost per screening, $ | 29.23 | ± 25% | See text |
| Treatment cost, annual, $ | 18.23 | ± 25% | See text |
| Cholesterol screening | |||
| High-density lipoprotein, median treatment efficacy, mg/dL | +1.6 | Not considered | 4S,33 Downs,34 Holdaas,32 Sever,33 Knopp,37 MRC/BHF,38 LIPID,39 Shepherd40,41 |
| Low-density lipoprotein, median treatment efficacy, mg/dL | −49.9 | Not considered | 4S,33 Downs,34 Holdaas,32 Sever,33 Knopp,37 MRC/BHF,38 LIPID,39 Shepherd40,41 |
| Cost per screening, $ | 55.56 | ± 25% | See text |
| Treatment and management cost, annual, $ | 528.00 | ± 25% | See text |
| Hypertension screening | |||
| Systolic blood pressure, median treatment efficacy, mm Hg | −6.5 | Not considered | Liu,42 Beckett,43 MRC,44 MRC,45 PROGRESS,46 SHEP,47 Dahlof,48 Liu,49 Staessen50 |
| Cost per screening, $ | 29.23 | ± 25% | See text |
| Treatment and management annual cost, $ | 278.52 | ± 25% | See text |
| All services | |||
| Aspirin use rate, primary/secondary prevention, % | 77/86 | ± 10% points | NHIS51 |
| Blood pressure and lipid medication use rates, primary/secondary prevention, % | |||
| Age 18–39 y | 62/77 | ± 10% points | NHANES52–56 |
| Age 40–64 y | 84/89 | ± 10% points | NHANES52–56 |
| Age >65 y | 94/97 | ± 10% points | NHANES52–56 |
| Myocardial infarction cost, 1st y/ongoing, $ | 37,095/2,490 | ± 25% | AHRQ/MEPS57 |
| Myocardial infarction QALY decrement, 1st y/ongoing | 0.3 (3 mo)/0.0 | ± 0.1 QALY | Maciosek58 |
| Screening and counseling acceptance rate, % | 90 | ± 10% points | Assumed |
| Stroke cost, 1st y/ongoing, $ | 18,192/5,389 | ± 25% | AHRQ/MEPS57 |
| Stroke QALY decrement, 1st y/ongoing | 0.4/0.4 | ± 0.1 QALY | Maciosek58 |
| Treatment effectiveness, % | 70 | ± 10% points | Calibrated assumption |
4S = Scandinavian Simvastatin Survival Study; AHRQ = Agency for Healthcare Research and Quality; CVD = cardiovascular disease; MEPS = Medical Expenditure Panel Survey; NCEP = National Cholesterol Education Program; NCHS = National Center for Health Statistics; NHANES = National Health and Nutrition Examination Survey; QALY = quality-adjusted life years; RR = relative risk; SHEP = Systolic Hypertension in the Elderly Program.
↵a The sensivity range indicates the lower and upper bounds (ie, worst case/best case) used in the deterministic sensitivity analysis.