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Healthcare delivery, economics and global health
Original research article
A policy model of cardiovascular disease in moderate-to-advanced chronic kidney disease
  1. Iryna Schlackow1,
  2. Seamus Kent1,
  3. William Herrington2,
  4. Jonathan Emberson2,
  5. Richard Haynes2,
  6. Christina Reith2,
  7. Christoph Wanner3,
  8. Bengt Fellström4,
  9. Alastair Gray1,
  10. Martin J Landray2,
  11. Colin Baigent2,5,
  12. Borislava Mihaylova1
  13. on behalf of the SHARP Collaborative Group
  1. 1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3 Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
  4. 4 University Hospital, Uppsala, Sweden
  5. 5 Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Borislava Mihaylova, Health Economic Research Centre, Nuffield Department of Population Health, Old Road Campus, Oxford OX3 7LF, UK; boby.mihaylova{at}dph.ox.ac.uk

Abstract

Objective To present a long-term policy model of cardiovascular disease (CVD) in moderate-to-advanced chronic kidney disease (CKD).

Methods A Markov model with transitions between CKD stages (3B, 4, 5, on dialysis, with kidney transplant) and cardiovascular events (major atherosclerotic events, haemorrhagic stroke, vascular death) was developed with individualised CKD and CVD risks estimated using the 5 years’ follow-up data of the 9270 patients with moderate-to-severe CKD in the Study of Heart and Renal Protection (SHARP) and multivariate parametric survival analysis. The model was assessed in three further CKD cohorts and compared with currently used risk scores.

Results Higher age, previous cardiovascular events and advanced CKD were the main contributors to increased individual disease risks. CKD and CVD risks predicted by the state-transition model corresponded well to risks observed in SHARP and external cohorts. The model’s predictions of vascular risk and progression to end-stage renal disease were better than, or comparable to, those produced by other risk scores. As an illustration, at age 60–69 years, projected survival for SHARP participants in CKD stage 3B was 13.5 years (10.6 quality-adjusted life years (QALYs)) in men and 14.8 years (10.7 QALYs) in women. Corresponding projections for participants on dialysis were 7.5 (5.6 QALYs) and 7.8 years (5.4 QALYs). A non-fatal major atherosclerotic event reduced life expectancy by about 2 years in stage 3B and by 1 year in dialysis.

Conclusions The SHARP CKD-CVD model is a novel resource for evaluating health outcomes and cost-effectiveness of interventions in CKD.

Trial registration number NCT00125593 and ISRCTN54137607; Post-results.

  • chronic kidney disease
  • cardiovascular risk
  • CKD progression
  • markov model
  • life expectancy

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2016-310970

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    Footnotes

    • Contributors Research idea and study design: BM, IS, WH, JE, RH, AG, MJL, CB; data acquisition: CB, MJL, WH, RH, CR, CW, BF; data analysis and interpretation: IS, BM, SK, WH, JE, RH, CR, MJL, CB; supervision or mentorship: BM, CB. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. BM and IS take responsibility that this study has been reported honestly, accurately and transparently; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

    • Funding The study was funded by Merck & Co., Whitehouse Station, NJ USA, with additional support from the Australian National Health Medical Research Council, the British Heart Foundation (CH/1996001/9454) and the UK Medical Research Council (A310). SHARP was initiated, conducted and interpreted independently of the principal study funder (Merck & Co.).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethical approval was obtained from all study sites prior to enrollment into SHARP.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The procedure for considering requests for access to the SHARP data is available at the CTSU website (www.ctsu.ox.ac.uk\).

    • Collaborators The SHARP Collaborative Group steering committee comprises R. Collins (chair), C. Baigent (study coordinator and chief investigator), M.J. Landray (clinical coordinator and co-principal investigator), C. Bray, Y. Chen (administrative coordinators), A. Baxter, A. Young (computing coordinators), M. Hill (director, central laboratory), C. Knott (nursing coordinator), A. Cass, B. Feldt-Rasmussen, B. Fellström, D.E. Grobbee, C. Grönhagen-Riska, M. Haas, H. Holdaas, L.S. Hooi, L. Jiang, B. Kasiske, U. Krairittichai, A. Levin, Z.A. Massy, V. Tesar, R. Walker, C. Wanner, D.C. Wheeler, A. Wiecek (national coordinators), T. Dasgupta, W. Herrington, D. Lewis, M. Mafham, W. Majoni, C. Reith (clinical support), J. Emberson, S. Parish (statistics), D. Simpson (lay member), J. Strony, T. Musliner (Merck Schering Plough, non-voting), L. Agodoa, J. Armitage, Z. Chen, J. Craig, D. de Zeeuw, J. M. Gaziano, R. Grimm, V. Krane, B. Neal, V. Ophascharoensuk, T. Pedersen, P. Sleight, J. Tobert and C. Tomson.