Abstract
BackgroundChronic diseases, represented mainly by cardiovascular disease (CVD) and cancer, are increasing in developing countries and account for 53% of chronic diseases in Argentina. There is strong evidence that a reduction of 50% of the deaths due to CVD can be attributed to a reduction in smoking, hypertension and hypercholesterolemia. Generalized cost-effectiveness analysis (GCE) is a methodology designed by WHO to inform decision makers about the extent to which current or new interventions represent an efficient use of resources. We aimed to use GCE analysis to identify the most efficient interventions to decrease CVD.MethodsSix individual interventions (treatment of hypertension, hypercholesterolemia, smoking cessation and combined clinical strategies to reduce the 10 year CVD Risk) and two population-based interventions (cooperation between government, consumer associations and bakery chambers to reduce salt in bread, and mass education strategies to reduce hypertension, hypercholesterolemia and obesity) were selected for analysis. Estimates of effectiveness were entered into age and sex specific models to predict their impact in terms of age-weighted and discounted DALYs saved (disability-adjusted life years). To translate the age- and sex-adjusted incidence of CVD events into health changes, we used risk model software developed by WHO (PopMod). Costs of services were measured in Argentine pesos, and discounted at an annual rate of 3%. Different budgetary impact scenarios were explored.ResultsThe average cost-effectiveness ratio in argentine pesos (ARS$) per DALY for the different interventions were: (i) less salt in bread $151; (ii) mass media campaign $547; (iii) combination drug therapy provided to subjects with a 20%, 10% and 5% global CVD risk, $3,599, $4,113 and $4,533, respectively; (iv) high blood pressure (HBP) lowering therapy $7,716; (v) tobacco cessation with bupropion $ 33,563; and (iv) high-cholesterol lowering therapy with statins $ 70,994.ConclusionAgainst a threshold of average per capita income in Argentina, the two selected population-based interventions (lowering salt intake and health education through mass-media campaigns) plus the modified polypill strategy targeting people with a 20% or greater risk were cost-effective. Use of this methodology in developing countries can make resource-allocation decisions less intuitive and more driven by evidence.
Highlights
Chronic diseases, represented mainly by cardiovascular disease (CVD) and cancer, are increasing in developing countries and account for 53% of chronic diseases in Argentina
[3] Primary data describing the prevalence and distribution of cardiovascular risk factors in the city of Buenos Aires has recently been obtained through two different population-based sources: the 2004 Ministry of Health National Risk Factor Survey [4]; and the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) [5]. The former surveyed a probabilistic sample of almost 50,000 households from all Argentine districts to detect risk factors, and the latter assessed the prevalence of cardiovascular risk factors and common carotid intimamedia wall thickness distributions in a probabilistic sample of individuals living in 7 cities in Latin American, including Buenos Aires
The WHO recently addressed the importance of chronic disease prevention as a neglected health issue in low- and middle-income countries; achievement of the global goal to reduce chronic disease death rates by 2% every year would avert 36 million deaths between 2005 and 2015. [6,7] Achieving this target would save almost 10% of the expected loss in national income in these settings[8] There is strong evidence that a 50% reduction in cardiovascular deaths can be attributable to the reduction of just three modifiable risk factors, namely tobacco consumption, high blood pressure and elevated cholesterol
Summary
Chronic diseases, represented mainly by cardiovascular disease (CVD) and cancer, are increasing in developing countries and account for 53% of chronic diseases in Argentina. The WHO recently addressed the importance of chronic disease prevention as a neglected health issue in low- and middle-income countries; achievement of the global goal to reduce chronic disease death rates by 2% every year would avert 36 million deaths between 2005 and 2015. [6,7] Achieving this target would save almost 10% of the expected loss in national income in these settings[8] There is strong evidence that a 50% reduction in cardiovascular deaths can be attributable to the reduction of just three modifiable risk factors, namely tobacco consumption, high blood pressure and elevated cholesterol [8] at least 75% of CVD can be explained by more proximal risk factors like unhealthy diet, low physical activity and tobacco consumption The WHO recently addressed the importance of chronic disease prevention as a neglected health issue in low- and middle-income countries; achievement of the global goal to reduce chronic disease death rates by 2% every year would avert 36 million deaths between 2005 and 2015. [6,7] Achieving this target would save almost 10% of the expected loss in national income in these settings[8] There is strong evidence that a 50% reduction in cardiovascular deaths can be attributable to the reduction of just three modifiable risk factors, namely tobacco consumption, high blood pressure and elevated cholesterol [8] at least 75% of CVD can be explained by more proximal risk factors like unhealthy diet, low physical activity and tobacco consumption
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