Table 1.
Annual parameter inputs.
| Domain | Description | Baseline (range)*/[95% CI] | Distributions Beta (α, β) Log normal (μ, σ) Gamma (α, β) | Sources |
|---|---|---|---|---|
| Initial distribution | Low PCE risk | 0.410 (0.205–0.615) | Beta (8.660, 12.460) | (2) |
| Moderate PCE risk | 0.363 (0.181–0.544) | Beta (9.450, 16.580) | (2) | |
| High PCE risk | 0.227 (0.114–0.341) | Beta (11.610, 39.530) | (2) | |
| Enrollment | Employee participation in WHP | 0.520 (0.260–0.780) | Beta (6.860, 6.330) | (80) |
| Risk of CAD† | High PCE risk | 0.022 (0.017–0.027) | Beta (76.390, 3380.450) | (9) |
| Moderate PCE risk | 0.013 (0.005–0.022) | Beta (9.330, 697.440) | (9) | |
| OR of CAD (high PRS) | 1.900 (1.800–2.000) | Log normal (0.640, 0.050) | (2) | |
| HR of CAD (with diabetes) | 2.000 [1.830–2.190] | Log normal (0.570, 0.220) | (13) | |
| CAD after ischemic stroke | 0.017 (0.014–0.019) | Beta (174.590, 10095.920) | (12) | |
| Ischemic Stroke | Risk ischemic stroke | 0.004 (0.003–0.005) | Beta (95.650, 23817.310) | (81) |
| Risk of ischemic stroke after CAD | 0.015 | (69) | ||
| HR of ischemic stroke with diabetes | 2.270 [1.950–2.650] | Log normal (0.370, 0.260) | (13) | |
| Risk of ischemic stroke post-hemorrhagic stroke | 0.057 [0.048–0.068] | Beta (117.640, 1946.260) | (15) | |
| Statin effectiveness | HR of CAD risk reduction | 0.560 [0.400–0.780] | Log normal (−0.580, 0.090) | (17) |
| HR for ischemic stroke risk reduction | 0.770 [0.630–0.940] | Log normal (−0.260, 0.080) | (18) | |
| Adherence | Statin adherence | 0.500 (0.400–0.600) | Beta (47.520, 47.520) | Assumption (22, 23) |
| Statin side effects | Risk of myopathy | 0.0001 (0.0001–0.0002) | Beta (2397.880, 4793360.990) | (25) |
| Risk of diabetes | 0.0015 (0.0010–0.0020) | Beta (847.590, 112165.190) | (25) | |
| Risk of hemorrhagic stroke | 0.0002 (0.0001–0.0002) | Beta (862.670, 1149370.300) | (25) | |
| Mortality‡ | Risk of death, acute CAD | 0.228 (0.182–0.274) | Beta (73.910, 250.270) | (26) |
| Risk of death, post-acute CAD | 0.070 (0.067–0.072) | Beta (14100.390, 58209.330) | (28) | |
| HR (diabetes and CAD) | 1.810 [1.440–2.280] | Log normal (0.690, 0.090) | (30) | |
| Risk of death after ischemic stroke or hemorrhagic stroke and CAD | 0.075 (0.050–0.100) | Beta (88.720, 1094.730) | Assumption (70) | |
| Risk of death, acute ischemic stroke | 0.100 (0.080–0.120) | Beta (86.340, 777.020) | (27) | |
| Risk death, post-hemorrhagic or post-ischemic stroke | 0.069 (0.055–0.082) | Beta (89.390, 1215.650) | (29) | |
| RR (with diabetes and ischemic stroke) | 1.670 (1.580–1.760) | Log normal (0.800, 0.180) | (31) | |
| Risk, acute hemorrhagic stroke | 0.390 (0.330–0.450) | Beta (98.620, 154.250) | (27) | |
| HR (diabetes versus no diabetes) | 1.680 [1.520–1.870] | Log normal (0.510, 0.090) | (30) | |
| Utility weights§ | CAD | 0.790 (0.730–0.860) | Beta (118.380, 31.46)0 | (32) |
| Myopathy | 0.917 (0.896–0.938) | Beta (697.060, 54.950) | (34) | |
| Diabetes | 0.800 (0.620–0.980) | Beta (14.380, 3.590) | (33) | |
| Stroke | 0.630 (0.440–0.780) | Beta (18.890, 11.090) | (32) | |
| Disutility weights | Acute CAD | 0.041 (0.021–0.062) | Beta (14.690, 343.730) | (36) |
| Acute stroke | 0.220 [0.180–0.260] | Beta (90.420, 320.590) | (37) | |
| Age disutility | 0.004 (0.002–0.006) | Beta (15.300, 3809.930) | (35) | |
| Costs | CAD-PRS test | 145 (116–174) | Gamma (96.040, 0.660) | Allelica, Inc |
| Standard-WHP | 58 (46–70) | Gamma (96.040, 1.660) | (82) | |
| Mobile health app | 6 (5–7) | Gamma (96.040, 16.010) | Allelica, Inc | |
| Primary care visit | 114 (91–137) | Gamma (96.040, 0.840) | (38) | |
| Statin therapy | 132 (106–158) | Gamma (96.040, 0.730) | (83) | |
| Background healthcare costs | 4,941 (3,953–5,930) | Gamma (96.040, 0.020) | (46) | |
| Acute | ||||
| Non-fatal CAD | 65,442 (43,818–100,531) | Gamma (20.460, 0.0003) | (39) | |
| Fatal CAD | 18,246 (14,597–21,896) | Gamma (96.040, 0.0053) | (40) | |
| Non-fatal ischemic stroke | 40,225 (11,539–100,184) | Gamma (3.160, 0.0001) | (39) | |
| Fatal ischemic stroke | 11,256 (9,005–13,507) | Gamma (96.040, 0.0085) | (40) | |
| Non-fatal hemorrhagic stroke | 38,246 (30,596–45,895) | Gamma (96.040, 0.0025) | (71) | |
| Fatal hemorrhagic stroke | 18,246 (14,597–21,896) | Gamma (96.040, 0.0053) | (40) | |
| Follow-up | ||||
| CAD | 11,815 (7,865–16,186) | Gamma (30.990, 0.003) | (72) | |
| Stroke (hemorrhagic/ischemic) | 20,005 (16,004 –24,006) | Gamma (96.040, 0.0048) | (41) | |
| Myopathy | 20,438 (16,351–24,536) | Gamma (96.040, 0.0047) | (45) | |
| Diabetes | 10,026 (8,021–12,031) | Gamma (96.040, 0.0096) | (44) | |
| Lost productivity | ||||
| (Year of diagnosis) | CAD/stroke | 73,492 (58,794–88,191) | Gamma (96.040–0.001) | (47, 48) |
| (Follow-up years) | CAD/stroke | 9,056 (7,245–10,868) | Gamma (96.040–0.011) | (47, 73) |
| Diabetes | 9,242 (7,393–11,090) | Gamma (97.040–0.010) | (47, 49) | |
| Myopathy | 9,056 (7,245–10,868) | Gamma (96.040–0.011) | (47, 73) | |
CAD, coronary artery disease; CI, confidence intervals; CAD-PRS, polygenic risk score for coronary artery disease; OR, odds ratio; HR, hazard ratio. *Range (+/- 20% of the baseline value, except for enrollment and initial distribution parameters to account for a wide variation (+/- 50%) in the estimate). The range and 95% CI were used in the sensitivity analysis. †Statin-induced myopathy did not change the risk of CAD and stroke or mortality (74–77). Further, the risk of CAD did not change after hemorrhagic stroke (15). ‡Mortality after stroke and CAD is significantly high compared to patients with only CAD or stroke. In a Medicare study population, more than 50% of patients with stroke and CAD died in the first year (70). Due to data limitations and our study population being younger compared to Medicare enrollment, we assumed 75% (50% - 100%) of patients will die in 10 years. We also assumed higher mortality for stroke among individuals with diabetes compared to those without diabetes based on a non-US study. Although no study has been carried out on the US population, studies including a meta-analysis showed increased mortality among stroke patients with diabetes (31, 78, 79). §Due to the lack of data on the quality-of-life utilities among patients with multiple conditions, we assumed the lowest utility among the combination of diseases.