Gazing through time and beyond the health sector: Insights from a system dynamics model of cardiovascular disease in Australia.

Sallie-Anne Pearson,Mark Heffernan,Kathy Trieu,Quan Huynh,Henry Cutler,Geoff Mcdonnell,Cindy Q Peng,Sean Lybrand,Danny Liew,Jo-An Occhipinti,Kenny D Lawson,Leonard Kritharides,Susan Horton,Tim Usherwood

doi:10.1371/journal.pone.0257760

Abstract

To construct a whole-of-system model to inform strategies that reduce the burden of cardiovascular disease (CVD) in Australia. A system dynamics model was developed with a multidisciplinary modelling consortium. The model population comprised Australians aged 40 years and over, and the scope encompassed acute and chronic CVD as well as primary and secondary prevention. Health outcomes were CVD-related deaths and hospitalisations, and economic outcomes were the net benefit from both the healthcare system and societal perspectives. The eight strategies broadly included creating social and physical environments supportive of a healthy lifestyle, increasing the use of preventive treatments, and improving systems response to acute CVD events. The effects of strategies were estimated as relative differences to the business-as-usual between 2019-2039. Probabilistic sensitivity analysis produced uncertainty intervals of interquartile ranges (IQR). The greatest reduction in CVD-related deaths was seen in strategies that improve systems response to acute CVD events (8.9%, IQR: 7.7-10.2%), yet they resulted in an increase in CVD-related hospitalisations due to future recurrent admissions (1.6%, IQR: 0.1-2.3%). This flow-on effect highlighted the importance of addressing underlying CVD risks. On the other hand, strategies targeting the broad environment that supports a healthy lifestyle were effective in reducing both hospitalisations (7.1%; IQR: 5.0-9.5%) and deaths (8.1% reduction; IQR: 7.1-8.9%). They also produced an economic net benefit of AU$43.3 billion (IQR: 37.7-48.7) using a societal perspective, largely driven by productivity gains. Overall, strategic planning to reduce the burden of CVD should consider the varying effects of strategies over time and beyond the health sector.

Highlights

Despite a dramatic decline in death rate of cardiovascular disease (CVD) over the last few decades, CVD remains the leading cause of death in Australia and the rate of decline has slowed [1]
Under the base-case scenario, it forecast an 80% increase in annual deaths and a 77% increase in annual hospitalisation from CVD from 2019 to 2039, equating to a total of approximately 1.3 million deaths and 11.7 million hospitalisations caused by CVD over 20 years in Australians over 40 years old
The model estimated an approximate distribution of 55:20:25 between deaths occurring during the pre-hospital stage of acute events, in-hospital stage of acute events, and in the community, while chronic CVD accounted for 60% of CVD-related hospitalisations

Summary

Introduction

Despite a dramatic decline in death rate of cardiovascular disease (CVD) over the last few decades, CVD remains the leading cause of death in Australia and the rate of decline has slowed [1]. This means loss of health to individuals and an economic burden to nations as a result of rising healthcare costs and lower productivity [2,3,4]. They need to balance prevention and treatment, clinical and behavioural influences, and individual interventions and population-wide changes.

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Discussion

Conclusion