Cost-effectiveness of a statewide public health intervention to reduce cardiovascular disease risk

Lauren Smith,Nick Flattery,Jon Campbell,Mori Krantz,Adam Atherly,Stephanie Coronel

doi:10.1186/s12889-019-7573-8

Abstract

BackgroundThe cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) risk-reduction interventions is not well established. Colorado Heart Healthy Solutions is a CHW-based intervention designed to reduce modifiable CVD risk factors. This program has previously demonstrated success, but the cost-effectiveness is unknown. CHW-based interventions are potentially attractive complements to healthcare delivery because laypersons implement the intervention at a lower cost relative to medical care and may be attractive in rural settings with limited clinical resources.MethodsCHWs performed screenings and provided ongoing participant support within predominantly rural communities. A point-of-service software tool was used to generate 10-year Framingham CVD risk scores and assist CHWs to make medical referrals and provide ongoing individualized support for lifestyle changes. A sample of program participants returned for reassessment of risk factors. We calculated quality-adjusted life years (QALYs) gained and program costs using a Markov model. Transition probabilities were calculated using Framingham risk equations or derived from the literature using the observed mean reduction in 10-year CVD risk score over of 37- months follow-up. Program cost-effectiveness was calculated for both at-risk (abnormal baseline CVD risk factors) and overall program populations.ResultsThe base-case scenario evaluating a 52-year-old male participant revealed an incremental cost savings of $3576 and a gain of 0.16 QALYs associated with the intervention. Cost savings were greater in at-risk populations. The economic dominance of the model was robust in multiple sensitivity analyses.ConclusionsA community-based CVD intervention demonstrated to reduce CVD risk is cost-effective. This suggests that population-based public health programs may have the potential to complement primary care preventative services to improve health and reduce the burden of traditional medical care.

Highlights

The cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) riskreduction interventions is not well established
We found that Colorado Heart Healthy Solutions is a cost-effective strategy, which generated cost savings through averted CVD events and suggests that community-based programs may have a role improving population health beyond traditional healthcare delivery
The models showed small gains in Quality-adjusted life years (QALY), but combined with the incremental cost savings of the program, the program was dominant compared with no intervention

Summary

Introduction

The cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) riskreduction interventions is not well established. Colorado Heart Healthy Solutions is a CHW-based intervention designed to reduce modifiable CVD risk factors. One approach to improving lifestyle and CVD risk factors is the use of community health workers, in which laypersons are trained to implement disease-specific health coaching interventions. Despite the dearth of cost-effectiveness studies, CHW-based interventions may augment healthcare delivery by providing ongoing support outside of the confines of the clinic. This may be important in rural areas where geographic and financial barriers limit ongoing preventive care. There is some evidence that a community health worker-based intervention is cost-effective in controlling diabetes [9]

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