Cardiovascular Disease Policy Model Research Group

The Cardiovascular Disease (CVD) Policy Model is a population-level state-transition computer simulation of cardiovascular disease. It has been used for more than 30 years to represent trends in CVD risk factors, outcomes and healthcare costs in the United States adult population.

Research using the CVD Policy Model focuses on understanding trends in CVD risk factors and treatments and evaluating the population-level impact of interventions aimed at reducing the burden of cardiovascular disease.

The model has been used to evaluate the impact and cost effectiveness of CVD prevention and treatment strategies ranging from public health interventions to clinically targeted approaches. Examples of past projects include assessing the impact of dietary salt reductions, soda taxation, emerging therapies to reduce low-density lipoprotein cholesterol, and implementation of national guidelines for treating elevated blood pressure.

Though originally designed to be nationally representative of the US population, the model has been adapted in recent years to examine subpopulations such as Veteran’s Affairs population and non-Hispanic blacks, as well as populations of other countries including Mexico, China, Argentina and Canada. This work has resulted in several high impact publications in the New England Journal of Medicine, JAMA, Annals of Internal Medicine, Circulation and Health Affairs.

The CVD Policy Model research group is a bicoastal, multi-disciplinary team of investigators and staff using computer simulation methods to address clinical and policy-oriented research questions related to cardiovascular disease. Dr. Kirsten Bibbins-Domingo leads the west coast CVD Policy Model team, which is located in the Department of Epidemiology and Biostatistics at the University of California San Francisco. She and her team collaborate closely with Drs. Lee Goldman and Andrew Moran at Columbia University in New York as well as diverse investigators, staff and trainees undertaking computer simulation modeling projects at UCSF, Columbia University and other institutions in the United States and around the world.

Samples of our published work can be found below. Researchers interested in learning more about our work should contact Dr. Kirsten Bibbins-Domingo (CVD Policy Model principal investigator) or Joanne Penko (CVD Policy Model project manager at UCSF).

Selected Publications Based on the CVD Policy Model

Upcoming Publication

Effect of Money-Back Guarantees on the Cost-Effectiveness of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors
Kazi DS, Penko J, Coxson PG, Ollendorf D, Bibbins-Domingo K.  Ann Intern Med. April 2018.

Outcomes-based pricing has been touted as a novel payment model for expensive drugs that improves access to new, high-cost drugs. Using the case of new lipid-lowering agents called PCSK9 inhibitors, we argue that while it may have worked well in other settings such as expensive chemotherapeutic agents for cancer, outcomes-based pricing is unlikely to improve the cost-effectiveness of expensive preventative therapies that have to be taken lifelong.

Full manuscript can be found at Annals.org

Online Supplement 

Health Policy

  • Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood LM, Pletcher MJ, Goldman L. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010;362(7):590-599.
  • Bibbins-Domingo K, Coxson P, Pletcher MJ, Lightwood J, Goldman L. Adolescent overweight and future adult coronary heart disease. N Engl J Med. 2007;357(23):2371-2379.
  • Coxson PG, Cook NR, Joffres M, Hong Y, Orenstein D, Schmidt S, Bibbins-Domingo K. Mortality benefits from US population-wide reduction in sodium consumption: projections from 3 modeling approaches. Hypertension. 2013;61(3):564-70.
  • Mekonnen TA, Odden MC, Coxson PG, Guzman D, Lightwood J, Wang YC, Bibbins-Domingo K. Health benefits of reducing sugar-sweetened beverage intake in high risk populations of California: results from the cardiovascular disease (CVD) policy model. PLoS One. 2013;8(12):e81723.
  • Wang YC, Coxson P, Shen YM, Goldman L, Bibbins-Domingo K. A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes. Health Aff 2012;31(1):199-207.
  • Odden MC, Coxson PG, Moran A, Lightwood JM, Goldman L, Bibbins-Domingo K. The impact of the aging population on coronary heart disease in the United States. Am J Med 2011;124(9):827-33.

Clinical Guidelines

  • Heller DJ, Coxson PG, Penko J, Pletcher MJ, Goldman L, Odden MC, Kazi DS, Bibbins-Domingo K. Evaluating the impact and cost-effectiveness of statin use guidelines for primary prevention of coronary heart disease and stroke. Circulation. 2017;136(12):1087-1098.
  • Moran AE, Odden MC, Thanataveerat A, et al. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med. 2015;372(5):447-455.
  • Pletcher MJ, Lazar L, Bibbins-Domingo K, Moran A, Rodondi N, Coxson P, Lightwood J, Williams L, Goldman L. Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering. Ann Intern Med. 2009;150(4):243-54. 

Clinical Medicine

  • Kazi DS, Moran AE, Coxson PG, et al. Cost-effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease. JAMA. 2016;316(7):743-753. doi: 710.1001/jama.2016.11004.
  • Kazi DS, Penko J, Coxson PG, Moran AE, Ollendorf DA, Tice JA, et al. Updated Cost-effectiveness Analysis of PCSK9 Inhibitors Based on the Results of the FOURIER Trial. JAMA. 2017;318:748-50. doi: 10.1001/jama.2017.9924.
  • Lazar LD, Pletcher MJ, Coxson PG, Bibbins-Domingo K, Goldman L. Cost-effectiveness of statin therapy for primary prevention in a low-cost statin era. Circulation. 2011;124:146-53.
  • Odden MC, Moran AE, Coxson PG, Peralta CA, Goldman L, Bibbins-Domingo K. Gait speed as a guide for blood pressure targets in older adults: a modeling study. J Am Geriatr Soc 2016;64(5):1015-23.
  • Odden MC, Pletcher MJ, Coxson PG, Thekkethala D, Guzman D, Heller D, Goldman L, Bibbins-Domingo K. Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States. Ann Intern Med 2015;162(8):533-541. 

Global Health

  • Konfino J, Mekonnen TA, Coxson PG, Ferrante D, Bibbins-Domingo K. Projected impact of sodium consumption reduction initiative in Argentina: an analysis from the CVD Policy Model-Argentina. PLoS One. 2013;8(9):e73824.
  • Sanchez-Romero LM, Penko J, Coxson PG, Fernandez A, Mason A, Moran AE, Avila-Burgos L, Odden M, Barquera S, Bibbins-Domingo K. Projected impact of Mexico’s sugar-sweetened beverage tax policy on diabetes and cardiovascular disease: a modeling study. PLoS Med. 2016;13(11)e1002158.

 

Interested Collaborators

Investigators interested in working with the CVD Policy Model software can contact Dr. Bibbins-Domingo. Please submit a 1- to 2-page research proposal and collaboration plan for the CVD Policy Model team to consider. The team will talk with interested researchers in order to assess the feasiblity of collaboration and clarify the research questions, particularly regarding whether the CVD Policy Model is designed to address the question. 

The CVD Policy Model Research Group has developed a Creative Commons agreement that establishes rules for collaboration with outside researchers whose proposals are approved. The agreement allows appropriate use of the software and asks collaborators to share modications and improvements to the software with the CVD Policy Model Research Group.

            Creative Commons Agreement

Opening for Post-Doctoral Scholar

The Cardiovascular Disease Policy Model research group, seeks a highly motivated scholar to join our multidisciplinary team for a 2-3 year postdoctoral fellowship. The fellow will collaborate closely with Drs. Kirsten Bibbins-Domingo and Dhruv Kazi to develop and disseminate original research that supports the group’s research agenda and enhances the capabilities of the CVD Policy Model. Additional details are available here.