Abstract
BackgroundCardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions.MethodsAn epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years.ResultsAn estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved)ConclusionsMost of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.
Highlights
Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL)
Selection of Risk Factors We selected specific risk factors that fulfilled the following criteria: (1) Sufficient evidence was available on the presence and magnitude of likely causal association with coronary heart disease (CHD) and stroke from high-quality epidemiological studies, (2) available interventions existed to modify associated risk, (3) data on risk factor prevalence was available from the First Argentinean Survey of Risk Factors (FASRF) or other nationally representative surveys not subjected to selection bias
Burden of Disease attributable to modifiable cardiovascular Risk Factors Population attributable risks, costs of events and Disability Adjusted Life Years (DALY) lost to cardiovascular disease for the overall risk factors and for each single modifiable risk factor selected, can
Summary
Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions. The age-adjusted mortality rate of cardiovascular disease, including CHD and stroke was 206.4 per 100,000 (265.4 for men and 161.8 for women), representing 34.2% of deaths and 12.6% of years of potential life lost [2]. Population and community-based interventions appear to be highly cost-effective when they reach large populations, address high mortality and morbidity diseases, and include multi-level integrated efforts. Recent studies have consistently shown the cost-effectiveness of interventions that lower the burden of cardiovascular disease in developing countries [12,13,14]
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