Homer Jack, Wile Kristina, Yarnoff Benjamin, Trogdon Justin G, Hirsch Gary, Cooper Lawton, Soler Robin, Orenstein Diane
Homer Consulting, Barrytown, New York.
Sustainability Institute, Charleston, South Carolina.
Prev Chronic Dis. 2014 Nov 6;11:E195. doi: 10.5888/pcd11.140130.
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.
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 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.
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.
计算机模拟能够以一种在现实世界中无法实现的可控且系统的方式，比较各种降低心血管疾病风险的干预措施。
我们使用预防影响模拟模型（PRISM）来分析50个干预杠杆的效果，这些干预杠杆根据其是既定的还是新出现的，以及是在医疗保健（临床、心理健康和行为服务）、空气（吸烟、二手烟和空气污染）或生活方式（营养和体育活动）等政策领域发挥作用，被分为6个（2×3）组群。通过概率敏感性分析确定不确定性范围。
结果表明，到2040年，所有6个干预组群综合起来可使心血管疾病风险相关死亡率累计降低49%至54%，使风险因素归因成本降低13%至21%。大部分死亡人数的减少将来自既定干预措施，但新出现的干预措施也将做出重大贡献。成本降低的微弱多数将来自新出现的干预措施。
PRISM使公共卫生官员能够研究不同类型的干预措施——既定的和新出现的——对降低心血管疾病风险的潜在影响。我们的模型表明，既定干预措施仍可对降低死亡人数和成本做出很大贡献，特别是通过更多地使用知名的预防和急性临床护理方法，而新出现的干预措施有可能做出重大贡献，特别是通过某些类型的预防护理和改善营养。
