gms | German Medical Science

Entscheiden trotz Unsicherheit: 14. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

15.03. - 16.03.2013, Berlin

Combining evidence for projecting outcomes – validation of a microsimulation model

Meeting Abstract

  • corresponding author presenting/speaker Felicitas Kühne - Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
  • author Annette Conrads-Frank - Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
  • author Sarah Kürwitz - Department of General Practice and Family Medicine, Philipps-University, Marburg, Germany
  • author Nikita Jegan - Department of General Practice and Family Medicine, Philipps-University, Marburg, Germany
  • author Charles Christian Adarkwah - Department of General Practice and Family Medicine, Philipps-University, Marburg, Germany
  • author Uwe Popert - Department of General Practice, Georg-August-University, Göttingen, Germany
  • author Norbert Donner-Banzhoff - Department of General Practice and Family Medicine, Philipps-University, Marburg, Germany
  • author Uwe Siebert - Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Entscheiden trotz Unsicherheit. 14. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Berlin, 15.-16.03.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13ebmP43

doi: 10.3205/13ebm058, urn:nbn:de:0183-13ebm0588

Veröffentlicht: 11. März 2013

© 2013 Kühne et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

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.