Cardiovascular Disease Prevention for people at high risk: Return on Investment Tool V1.0

An adaptation of the School for Public Health Research (SPHR) diabetes prevention model, which was developed with funding from the National Institute for Health Research (NIHR)

The CVD Prevention RoI Tool will help you to understand the costs, savings and health benefits likely to be produced by implementing a range of interventions or improvements in detection and/ or management in your local authority (LA), clinical commissioning group (CCG) or sustainability and transformation plan (STP) footprint.

Aim of the tool

The aim of the tool is to help you to explore the impact of changes to CVD prevention strategies in people at high risk in your local area in terms of clinical events, mortality, costs and health benefits.

Scope of the Tool

The tool includes demographic information about your local population, so that the outcomes are specific to your area. You can select the locality of interest from the full range of CCGs, STPs and local authorities in England, or for the whole of England. The current tool includes only CVD prevention interventions aimed at people with one or more of the following risk factors: QRISK ≥ 10%; hypertension; familial hypercholesterolaemia (FH); atrial fibrillation (AF); diabetes (including type 1 and type 2 diabetes); non-diabetic hyperglycaemia; and chronic kidney disease (CKD). Primary prevention of CVD is not considered by this tool. Interventions were included in the tool if there was sufficient evidence around the effectiveness (see database of interventions and conditions for more details) and the included interventions were all recommended by NICE by the beginning of 2018. As such lifestyle interventions are currently under-represented in the tool; however there is the functionality for users to assess the impact of additional interventions that are happening in their local area if they have information on effectiveness of the intervention. The outcomes of the tool include clinical events, mortality, costs and health benefits. The tool includes costs and savings to the NHS and social care. It does not currently include wider societal costs. Further information about the design of the tool can be found in the accompanying report.

Key inputs and outputs

There are two types of questions that can be answered by the tool:

1. What happens when I improve detection or management of key CVD risk factors?

This allows users to consider the impact of changing the proportion of people detected or managed out of the people who have a specific CVD risk factor. Included CVD risk factors are: QRISK ≥ 10%; hypertension; familial hypercholesterolaemia; atrial fibrillation; diabetes; non-diabetic hyperglycaemia; and chronic kidney disease.

2. What happens when I improve usage of the key interventions for people at risk of CVD?

This allows users to consider the impact of changing the proportion of people with any CVD risk factor who 'use' specific detection and management interventions. Usage incorporates the proportion offered the intervention (of those eligible), uptake and retention of the intervention. Improvements in usage of the intervention might occur through offering more of the eligible population the intervention, increasing uptake and/ or reducing discontinuation of the intervention. Included interventions are: NHS health checks; annual review; cascade testing for FH; lipid modification therapy; anti-hypertensive therapy; anticoagulant therapy; blood glucose lowering medication; NHS diabetes prevention programme; structured diabetes education; weight management programmes; smoking cessation programmes; nutritional advice for CKD; insulin pump; pharmacist new medicines review; blood pressure self-monitoring; and user defined intervention.

For each of these questions, users can decide whether they want to phase in the intervention over up to 3 years. Depending upon the question the user selects to answer, the tool will show an estimate of the current proportion of individuals detected/ managed/ using an intervention, based on local sources where possible, but national sources where not. The user can modify these proportions if they have better local estimates. The user can then enter their target proportion of individuals detected/ managed/ using an intervention (future scenario).

There is also the option for users to input information about an intervention which is not currently included in the tool but that they may wish to evaluate.

Using the tool

Throughout the tool there are information boxes that you can click on to guide you further.

Following submission of the tool inputs, the underlying model will take some time to run (estimated to be about one hour per scenario tested depending on how many others are using the tool at the same time). You will receive an email when the results are ready containing a link to a user output webpage with your results. The results will be permanently stored in a database linked to the tool. The user output interface will include a range of interactive options to enable you to choose the type of outputs that are of most interest to you. Outputs will include a series of tables and graphs based predominantly around the incremental (additional) values for each chosen scenario compared with current care (e.g. additional clinical events avoided, additional costs/savings).

You will be able to:

  1. See the inputs that you selected for each scenario, as well as the numbers and proportions of people estimated to have each of the high risk conditions (including undiagnosed cases) currently in your local area.

  2. See particular results by selecting particular population subgroups (if desired), a time horizon and a set of output variables of interest. You can go back and change your customised reporting choices as many times as desired.

  3. Download a PDF of key results.

  4. Download an Excel table of detailed results to enable further data analysis by the user if required.

Through the email link, users will be able to return as often as they wish to their user output interface, so will be able to retrieve results or look at new outputs for the same analysis at a later date without having to rerun the model. An example of an output for a model run where the target usage of antihypertensives has been set to 100% in England can be found at the following link: https://cvd-prevention.shef.ac.uk/model_runs/258.

Exemplar analyses

A set of exemplar analyses based on national data can be found in the results section of the accompanying report. This shows an example of the types of results you could obtain and a set of analyses indicating the relative benefits of improving detection, management or usage of the interventions to help you design your own scenarios.

The model behind the tool

The underlying model is the ScHARR diabetes and CVD prevention model, full details of which can be found in the models technical document. This model follows individuals who are programmed to have similar characteristics and risk factors for CVD as those in the English population. Metabolic trajectories for body mass index, cholesterol, systolic blood pressure and glycaemia are predicted for each individual. Baseline characteristics and metabolic risk factors determine the individuals’ probability of CVD events, diabetes microvascular complications, cancer, osteoarthritis, depression and dementia. The model also predicts death from CVD, cancer and other causes. The outcomes of the tool will reflect any impact of the interventions on these related conditions as well as CVD. Long term costs and quality-adjusted life years are collected for each individual.

Disclaimer

This tool is based on a population-level model and should not be used to make clinical decisions about care of individual patients.

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