Artikel
Combining evidence for projecting outcomes – validation of a microsimulation model
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Veröffentlicht: | 11. März 2013 |
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Gliederung
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Background: Communicating the individual risk of a cardiovascular event is a common and important task of physicians. To improve this communication, a group of researchers of the University of Marburg developed the ARRIBA tool, which reports the individual 10-year probability of a cardiovascular event. To include lifetime risk and time-to-event estimates in this tool, a state-transition microsimulation model (STMM) was developed. This model incorporates evidence from different sources, to project the individual risk of cardiovascular events. The objective of this study was to estimate the validity of the model.
Methods: Berry and others [1] used data from 18 US observational cohort studies with a total of 257,384 subjects to estimate the lifetime risk of cardiovascular events. To validate our STMM, we populated it with 28 cohorts closely matching 7 risk profiles and 4 age groups of the Berry publication to simulate the observed events. Projected outcomes were proportion experiencing myocardial infarction, stroke, cardiovascular death, or any cardiovascular event. These outcomes simulated by our model were compared to the observed outcomes and their 95% confidence intervals (95% CI).
Results: When comparing the estimated lifetime risk of experiencing any cardiovascular event to the observed data, 15 (men) and 14 (women) of the 28 cohorts were within the 95% CI of the observed results. The other estimates were within 2.5 times this range. Although the observational study was a useful source for validation, the validation process was challenging with respect to matching cohorts and outcomes. One key issue is whether a validation to a US cohort study is suitable for a European model.
Conclusion: Although we had to make some assumptions on the patient mix as well as on the mix of risk factors within each of the population groups, the external validation increased our confidence in the microsimulation model and its use for projecting individual lifetime risk.
References
- 1.
- Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, Greenland P, Van Horn L, Tracy RP, Lloyd-Jones DM. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366(4):321-9.