The CHARMED model: a multimorbidity simulation model for people aging with HIV

CHARMED 模型：针对艾滋病毒老年患者的多发病模拟模型

基本信息

批准号：
10257768
负责人：
Emily Parker Hyle
金额：
$ 70.83万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10257768
关键词：
AIDS dementia Acquired Immunodeficiency Syndrome Address Advocate Age Age-Years Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Area Cardiovascular Diseases Caring Chronic Disease Clinical Clinical Trials Cohort Studies Collaborations Cost Analysis Cost Effectiveness Analysis Cost of Illness Data Dementia Development Diagnosis Disease Disease Outcome Disease model Economics Epidemiology Etiology Event Functional disorder Future General Population Goals Guidelines HIV Health Care Costs Heart Impaired cognition Incidence Individual International Intervention Life Expectancy Major Depressive Disorder Mental Depression Mental Health Methods Modeling Morbidity - disease rate National Institute on Aging Neurocognitive Outcome Patients Policies Population Prevention Prevention strategy Public Health Quality of life Recording of previous events Research Research Design Resources Risk Risk Factors Structural Models Time Treatment Effectiveness United States Update Vision Vulnerable Populations aged antiretroviral therapy cardiovascular disorder prevention care costs care outcomes clinical care clinically relevant cohort comorbidity cost cost effective cost effectiveness cost outcomes dementia risk depression model economic outcome effective therapy evidence base experience high risk improved innovation interest life time cost models and simulation modifiable risk mortality mortality risk multidisciplinary multiple chronic conditions novel prevent synergism virology

项目摘要

PROJECT SUMMARY Almost half of all people diagnosed with HIV in the United States are aged 50 or older, and they are at increased risk for dementia and multimorbidity. Dementia is of major clinical policy concern because it results in both inexorable clinical decline and extremely high costs of care. People with HIV are at particularly high risk because they often have major risk factors for the development of traditional etiologies of dementia, such as Alzheimer's Disease and Alzheimer's Disease-Related Dementias (AD/ADRD), and they also have a risk of HIV-associated neurocognitive disease (HAND) despite sustained virologic suppression. Depression, cardiovascular disease (CVD), and HIV are known to have potent synergies that contribute to the development of dementia. These comorbidities are modifiable risk factors for dementia that are highly prevalent, known to be undertreated in people with HIV, and likely to be clinically and economically important targets for prevention and management. The overall goal of this proposal is to provide an evidence-based approach for prioritizing and advocating for interventions to improve the quality of life and reduce morbidity and mortality among people aging with HIV. The benefits of reducing the burden of depression and CVD among people with HIV may currently be underestimated, given that concomitant benefits related to multimorbidity are often not captured due to short durations of observational or trial data. Determining which interventions are most clinically effective and cost- effective is critically important to understand so that people aging with HIV can benefit from strategies to reduce their risk of dementia and multimorbidity as they age. We propose to: 1) develop the Cognitive impairment, HIV, Aging, heaRt, MEntal health, and Dementia (CHARMED) Model, including populating the model with clinical and outcomes data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and nationally-representative cost data; 2) project clinical and economic outcomes of people aging with HIV; and 3) perform cost-effectiveness analyses of targeted interventions to reduce the burden of depression and CVD and to quantify the resultant reduction in dementia and multimorbidity. This proposal comprises a unique collaboration of experts in methods that are complementary and essential to complete the research aims: clinical expertise, epidemiology of people aging with HIV, costing, simulation modeling, and cost-effectiveness analysis. The proposed innovative multimorbidity model will be the first to include these important comorbidities that are highly prevalent, demonstrate synergies that contribute to dementia, and are amenable to treatment. The model structure and parameterization can both be revised with the emergence of updated data and improved understanding of the synergies and pathophysiology. This simulation modeling approach will allow for analyses of clinical and policy questions that aim to improve clinical outcomes, improve quality of life, and reduce costs among people aging with HIV.

项目概要在美国，几乎一半被诊断出感染艾滋病毒的人年龄在 50 岁或以上，而且他们处于痴呆症和多种疾病的风险增加。痴呆症是临床政策的主要关注点，因为它会导致不可避免的临床衰退和极高的护理成本。艾滋病毒感染者面临特别高的风险因为他们往往具有导致痴呆症传统病因发展的主要风险因素，例如阿尔茨海默病和阿尔茨海默病相关痴呆症 (AD/ADRD)，而且它们还有以下风险：尽管存在持续的病毒学抑制，但仍发生与艾滋病毒相关的神经认知疾病（HAND）。沮丧，众所周知，心血管疾病（CVD）和艾滋病毒具有强大的协同作用，有助于发展痴呆症。这些合并症是痴呆症的可改变危险因素，非常普遍，众所周知 HIV 感染者的治疗不足，可能是临床和经济上重要的预防目标和管理。该提案的总体目标是提供一种基于证据的方法来确定优先顺序并倡导旨在改善艾滋病毒感染者的生活质量并降低发病率和死亡率的干预措施。目前，减轻艾滋病毒感染者抑郁症和心血管疾病负担的好处可能是被低估了，因为与多病相关的伴随效益往往由于时间短而未被捕获观察或试验数据的持续时间。确定哪些干预措施在临床上最有效且成本最低了解有效的方法至关重要，这样老年艾滋病毒感染者才能从以下策略中受益：随着年龄的增长，降低患痴呆症和多种疾病的风险。我们建议：1）发展认知能力损伤、艾滋病毒、衰老、心脏、心理健康和痴呆 (CHARMED) 模型，包括填充模型包含来自北美艾滋病队列研究合作的临床和结果数据设计（NA-ACCORD）和具有全国代表性的成本数据； 2) 项目临床和经济成果感染艾滋病毒的老年人； 3) 对有针对性的干预措施进行成本效益分析，以减少抑郁症和心血管疾病的负担，并量化由此产生的痴呆症和多种疾病的减少。该提案包括专家在方法上的独特合作，这些方法是互补且必不可少的完成研究目标：临床专业知识、艾滋病毒老龄化人群的流行病学、成本计算、模拟建模和成本效益分析。所提出的创新多发病模型将是第一个包括这些非常普遍的重要合并症，证明有助于痴呆症，并且可以接受治疗。模型结构和参数化都可以修改更新数据的出现以及对协同作用和病理生理学的理解得到提高。这模拟建模方法将允许分析临床和政策问题，旨在改善临床成果、改善生活质量并降低艾滋病毒感染者的成本。