Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis.

Mieraf Taddesse Tolla,Melanie Bertram,Ole Frithjof Norheim,Kirsten Strand,Solomon Tessema Memirie,Awel Ababulgu,Stéphane Verguet,Senbeta Guteta Abdisa,Degu Jerene,Kjell Arne Johansson

doi:10.1186/s12962-016-0059-y

Abstract

BackgroundThe coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia’s meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper’s objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting.MethodsFifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization’s Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and price of traded and non-traded goods. Costs and health benefits were discounted at 3 % per year. Incremental cost-effectiveness ratios are reported in US$ per disability adjusted life year (DALY) averted. Sensitivity analysis was undertaken to assess robustness of our results.ResultsCombination drug treatment for individuals having >35 % absolute risk of a CVD event in the next 10 years is the most cost-effective intervention. This intervention costs US$67 per DALY averted and about US$7 million annually. Treatment of acute myocardial infarction (AMI) (costing US$1000–US$7530 per DALY averted) and secondary prevention of IHD and stroke (costing US$1060–US$10,340 per DALY averted) become more efficient when delivered in integrated packages. At an annual willingness-to-pay (WTP) level of about US$3 million, a package consisting of aspirin, streptokinase, ACE-inhibitor and beta-blocker for AMI has the highest probability of being most cost-effective, whereas as WTP increases to > US$7 million, combination drug treatment to individuals having >35 % absolute risk stands out as the most cost-effective strategy. Cost-effectiveness ratios were relatively more sensitive to halving the effectiveness estimates as compared with doubling the price of drugs and laboratory tests.ConclusionsIn Ethiopia, the escalating burden of CVD and its risk factors warrants timely action. We have demonstrated that selected CVD intervention packages could be scaled up at a modest budget increase. The level of willingness-to-pay has important implications for interventions’ probability of being cost-effective. The study provides valuable evidence for setting priorities in an essential healthcare package for CVD in Ethiopia.

Highlights

The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia
A package consisting of aspirin, beta-blocker ACE-inhibitor and statin for secondary prevention of ischemic heart disease (IHD) costs US$1850 per disability adjusted life year (DALY) averted, while a package consisting of aspirin, ACE-inhibitor and statins for secondary prevention of stroke costs US$1060 per DALY averted
Our analysis illustrates that primary prevention of ischemic heart disease and stroke is a more efficient strategy for maximizing population-level health benefits compared with acute treatment and secondary prevention

Summary

Introduction

The Global Burden of Disease study estimated that about 32 % of all deaths worldwide in 2013 were caused by CVD [1], with about 80 % of these deaths occurring in low-and middle-income countries (LMIC) [1, 2]. Small-scale local studies reported an increasing burden from CVD and its risk factors, especially in urban settings in Ethiopia [4,5,6,7,8,9,10,11,12,13,14,15]. The prevalence of hypertension in Ethiopia is estimated to range from 16 to 30 % [5, 6, 13, 14]

Methods

Results

Discussion

Conclusion