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Guthrie B, Rogers G, Livingstone S, et al. The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis. Southampton (UK): National Institute for Health and Care Research; 2024 Feb. (Health and Social Care Delivery Research, No. 12.04.)
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The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis.
Show detailsOur patient and public representatives Alison Allen and Graham Bell made an indelible contribution to this project. We were saddened to hear of Graham Bell’s death in 2020.
Garima Dalal (The University of Manchester) contributed to analysis of the BWS data reported in Chapter 5.
At the University of Edinburgh, Megan McMinn contributed to the analysis of fracture data for Chapter 4, Jacques Fleuriot helped with implementation of QRISK-Lifetime C code and Chima Eke helped with implementation of QFracture-2012 C code.
Martin Harker developed the original statins cost-effectiveness model for CG181 at the National Clinical Guideline Centre. In addition, we are very grateful to David Wonderling, of the successor body, the National Guideline Centre, for providing us with an executable copy of the model to aid our replication.
We are grateful to all the survey respondents who gave us their opinions for Chapter 5.
Study Advisory Group
We would like to thank the following Study Advisory Group members for their invaluable advice and contribution to the project: Liam Smeeth (chairperson, London School of Hygiene and Tropical Medicine), Alison Allen (patient and public involvement representative), Graham Bell (patient and public involvement representative), Gerry Richardson (University of York) and Nichole Taske (NICE; for whom Joshua Pink also deputised).
Ethics
The literature elements of the study did not require ethics review. The prediction modelling used CPRD data and the protocol was approved by the CPRD Independent Scientific Advisory Committee (reference number 16_248). The DTD elicitation study was reviewed by the Health Research Authority (Integrated Research Application System project ID 220,492) and granted ethics approval (Research Ethics Committee reference 17/NW/0124).
Contributions of authors
Bruce Guthrie (https://orcid.org/0000-0003-4191-4880) (Professor of General Practice, The University of Edinburgh) was the overall chief investigator, contributed to the conceptualisation, conduct and interpretation of the study, co-ordinated the writing of the report, led the writing of Chapters 1–4 and 8, and wrote elements of Chapters 5–7.
Gabriel Rogers (https://orcid.org/0000-0001-9339-7374) (Senior Research Fellow in Health Economics, The University of Manchester) contributed to the conduct and interpretation of the study, led the writing of Chapters 6 and 7, co-wrote Chapter 4, and provided comment on and editing of the report.
Shona Livingstone (https://orcid.org/0000-0002-4621-8713) (Statistician, University of Dundee) was the employed researcher in Dundee, contributed to the conduct and interpretation of the study, and provided comment on and editing of the report.
Daniel Morales (https://orcid.org/0000-0002-0063-8069) (Wellcome Trust Clinical Research Career Development Fellow, University of Dundee) contributed to the conceptualisation, conduct and interpretation of the study, and provided comment on and editing of the report.
Peter Donnan (https://orcid.org/0000-0001-7828-0610) (Professor of Epidemiology and Biostatistics, University of Dundee) was co-chief investigator, contributed to the conceptualisation, conduct and interpretation of the study, and provided comment on and editing of the report.
Sarah Davis (https://orcid.org/0000-0002-6609-4287) (Senior Lecturer in Health Economics, The University of Sheffield) contributed to the conceptualisation, conduct and interpretation of the study, co-wrote Chapter 7, and provided comment on and editing of the report.
Ji Hee Youn (https://orcid.org/0000-0003-1382-495X) (Research Associate in Health Economics at The University of Manchester) contributed to the conduct and interpretation of the study, co-wrote Chapter 5, and provided comment on and editing of the report.
Rob Hainsworth (https://orcid.org/0000-0002-3475-800X) (Research Associate in Health Economics, The University of Manchester) contributed to the conduct and interpretation of the study, co-wrote Chapter 6, and provided comment on and editing of the report.
Alexander Thompson (https://orcid.org/0000-0003-4930-5107) (Senior Research Fellow in Health Economics, The University of Manchester) contributed to the conceptualisation, conduct and interpretation of the study, led the writing of Chapter 5, co-wrote Chapter 6, and provided comment on and editing of the report.
Katherine Payne (https://orcid.org/0000-0002-3938-4350) (Professor of Health Economics, The University of Manchester) led the health economics work, contributed to the conceptualisation, conduct and interpretation of the study, co-wrote Chapter 4, and provided comment on and editing of the report.
Publications
Livingstone S, Morales DR, Donnan PT, Payne K, Thompson AJ, Youn JH, et al. Effect of competing mortality risks on predictive performance of the QRISK3 cardiovascular risk prediction tool in older people and those with comorbidity: external validation population cohort study. Lancet Healthy Longev 2021;2:e352–61. https://doi.org/10.1016/S2666-7568(21)00088-X
Livingstone SJ, Guthrie B, Donnan PT, Thompson A, Morales DR. Predictive performance of a competing risk cardiovascular prediction tool CRISK compared to QRISK3 in older people and those with comorbidity: population cohort study. BMC Med 2022;20:152.
Livingstone S, Guthrie B, McMinn M, Eke C, Donnan P, Morales D. Predictive performance of a competing risk fracture prediction tool CFracture compared to QFracture in older people and those with comorbidity: population cohort study. Lancet Healthy Longev 2022;4:e43–e53.
Livingstone S, Morales DR, McMinn M, Eke C, Donnan PT, Guthrie B. Impact of competing mortality risks on predictive performance of the QFracture risk prediction tool for major osteoporotic fracture and hip fracture: external validation cohort study in a UK primary care population. BMJ Med 2022;1:e000316. https://doi.org/10.1136/bmjmed-2022-000316
Livingstone S, Morales DR, Fleuriot J, Donnan PT, Guthrie B. External validation of the QLifetime cardiovascular risk prediction tool: population cohort study. BMC Cardiovasc Disord 2023;23:194. https://doi.org/10.1186/s12872-023-03209-8
Data-sharing statement
The data used in the risk prediction modelling are controlled by the CPRD, and under the data licence granted the authors are not allowed to share the data. Researchers can apply to CPRD directly for access to the raw data. For the health economics modelling, the parameters of the models are all fully documented in this final report and the documents it cites, and there are no additional data to share. If you have any further queries, please contact the corresponding author.
Patient data
This work uses data provided by patients and collected by the NHS as part of their care and support. Using patient data is vital to improve health and care for everyone. There is huge potential to make better use of information from people’s patient records, to understand more about disease, develop new treatments, monitor safety and plan NHS services. Patient data should be kept safe and secure, to protect everyone’s privacy, and it is important that there are safeguards to make sure that they are stored and used responsibly. Everyone should be able to find out about how patient data are used. #datasaveslives You can find out more about the background to this citation here: https://understandingpatientdata.org.uk/data-citation.
Disclaimers
This report presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.
- Acknowledgements - The implications of competing risks and direct treatment disu...Acknowledgements - The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis
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