title: Simulating the impact of improved cardiovascular risk interventions on clinical and economic outcomes in Russia.
abstract: OBJECTIVE
  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.
authors.affiliation: Archimedes, San Francisco, California, United States of America.
authors.forename: Kenny
authors.initials: K
authors.lastname: Shum
authors.affiliation: Archimedes, San Francisco, California, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Alperin
authors.affiliation: National Research Center for Preventive Medicine, Moscow, Russia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Shalnova
authors.affiliation: National Research Center for Preventive Medicine, Moscow, Russia.
authors.forename: Sergey
authors.initials: S
authors.lastname: Boytsov
authors.affiliation: National Research Center for Preventive Medicine, Moscow, Russia.
authors.forename: Anna
authors.initials: A
authors.lastname: Kontsevaya
authors.affiliation: Novartis Pharma LLC, Moscow, Russia.
authors.forename: Alexey
authors.initials: A
authors.lastname: Vigdorchik
authors.affiliation: Archimedes, San Francisco, California, United States of America.
authors.forename: Adam
authors.initials: A
authors.lastname: Guetz
authors.affiliation: OptumInsight Life Sciences, Stockholm, Sweden.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Eriksson
authors.affiliation: Department of Healthcare Systems, Novartis International AG, Basel, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Hughes
mesh_terms: D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D055118:Medication Adherence; D018803:Models, Economic; D008962:Models, Theoretical; D012307:Risk Factors; D012426:Russia
chemical_list: D000959:Antihypertensive Agents