Using simulation to compare established and emerging interventions to reduce cardiovascular disease risk in the United States.
BACKGROUND
Computer simulation offers the ability to compare diverse interventions for reducing cardiovascular disease risks in a controlled and systematic way that cannot be done in the real world.


METHODS
We used the Prevention Impacts Simulation Model (PRISM) to analyze the effect of 50 intervention levers, grouped into 6 (2 x 3) clusters on the basis of whether they were established or emerging and whether they acted in the policy domains of care (clinical, mental health, and behavioral services), air (smoking, secondhand smoke, and air pollution), or lifestyle (nutrition and physical activity). Uncertainty ranges were established through probabilistic sensitivity analysis.


RESULTS
Results indicate that by 2040, all 6 intervention clusters combined could result in cumulative reductions of 49% to 54% in the cardiovascular risk-related death rate and of 13% to 21% in risk factor-attributable costs. A majority of the death reduction would come from Established interventions, but Emerging interventions would also contribute strongly. A slim majority of the cost reduction would come from Emerging interventions.


CONCLUSIONS
PRISM allows public health officials to examine the potential influence of different types of interventions - both established and emerging - for reducing cardiovascular risks. Our modeling suggests that established interventions could still contribute much to reducing deaths and costs, especially through greater use of well-known approaches to preventive and acute clinical care, whereas emerging interventions have the potential to contribute significantly, especially through certain types of preventive care and improved nutrition.
Homer Consulting, Barrytown, New York.
Jack
J
Homer
Sustainability Institute, Charleston, South Carolina.
Kristina
K
Wile
RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709. E-mail: byarnoff@rti.org.
Benjamin
B
Yarnoff
University of North Carolina, Chapel Hill, North Carolina.
Justin G
JG
Trogdon
Creator Learning Environments, Wayland, Massachusetts.
Gary
G
Hirsch
National Institutes of Health, Bethesda, Maryland.
Lawton
L
Cooper
Centers for Disease Control and Prevention, Atlanta, Georgia.
Robin
R
Soler
Centers for Disease Control and Prevention, Atlanta, Georgia.
Diane
D
Orenstein
D000397:Air Pollution / Q000009:adverse effects* / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003198:Computer Simulation; D003695:Delivery of Health Care; D006801:Humans; D008019:Life Style; D008605:Mental Health Services; D008962:Models, Theoretical; D012307:Risk Factors; D014481:United States / Q000453:epidemiology