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Healthy Caribbean Coalition - Cost effectiveness of CVD interventions in Argentina

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Reducing population-wide salt intake levels and using a targeted multi-drug therapy were shown to be cost-effective as well as lower the burden of cardiovascular disease in Argentina...

Title: Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

Authors: A Rubinstein, L Colantonio, A Bardach, J Caporale, et al.

Reference: BMC Public Health 2010; 10:627 (open access) http://www.biomedcentral.com/1471-2458/10/627/abstract

Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Reviewer comments: Chronic diseases in general, and CVD in particular, are increasing in magnitude and impact among persons living in developing countries. Despite these projected, as well as ongoing, increases in the magnitude and adverse health effects associated with these chronic conditions, limited data are available to estimate the burden of CVD attributed to modifiable predisposing factors and the cost-effectiveness of different intervention approaches to alter these coronary risk factors in developing as well as economically-developed countries. This is particularly important to assess given more limited financial and professional resources in developing countries and competing demands from other important public health and clinical problems.

The results of the present study, in which sophisticated analytical modeling was utilized to calculate the cost-effectiveness of different clinical and population-level interventions on CVD and its risk factors, suggest that the application of two interventions could be particularly effective in modifying the burden of CVD in Argentina. These included the lowering of population-wide salt levels through reducing the amount of salt used in the preparation of bread products and use of targeted multi-drug therapy to persons at high projected risk for developing CVD. In addition, several other interventions were shown to be reasonably cost-effective both in targeted population groups as well as in the general Argentinean population.

These results convincingly demonstrate that there are a number of cost-effective approaches that can be applied to the population as a whole, and at targeted individuals, to effectively reduce, or postpone to a later age, the risk of developing CVD. The general public should be informed of these approaches by their providers and government officials and should press them to apply these and other culturally acceptable cost-effective interventions to reduce the burden of CVD in their respective countries.

Purpose of study: To describe the population burden from CVD in Argentina and the cost-effectiveness of population-based and clinical interventions.

Location of study: Buenos Aires, Argentina

Study design: Statistical and epidemiological modeling

Results: The authors used data collected in the First Argentinean Survey of Risk Factors (FASRF) to model seven modifiable risk factors for CVD in the Argentinean population. These included high blood pressure, high cholesterol, overweight and obesity, serum glucose levels and diabetes, smoking, and physical inactivity. The FASRF is a nationally representative survey of more than 41,000 residents of Argentina. Data were also obtained from other information sources to carry out the investigator's statistical modeling approaches including national vital statistics data, disability adjusted life years, the impact of various interventions (e.g., treatment of high blood pressure or elevated serum cholesterol levels), and costs associated with acute events of CVD and impact of various interventions. These data were analyzed such that the individual and combined effects of population-based and clinical interventions that might modify the risks associated with these factors could be estimated. The risk factor interventions consisted of lowering the amount of salt in bread, mass media campaigns to promote smoking cessation, medical treatment of persons with high blood pressure and high serum cholesterol levels, and use of combination drug therapies for persons considered to be at particularly increased risk for CVD over the next decade.

Population-attributable risk estimates for each of the risk factors and diseases examined were calculated, disability adjusted life years, and estimates of fatal and non-fatal events of CVD. For example, population-attributable fractions of 39% were obtained for high blood pressure on the development of a heart attack and percentages of greater than 20% for tobacco use, overweight, high cholesterol levels, and physical inactivity. These data were subsequently incorporated into various modeling approaches.

Based on the available data and a number of working assumptions, slightly more than a quarter million events attributed to CVD and stroke were estimated to occur in the Argentinean population representing annual costs of more than US$1 billion; more than a million disability adjusted life years were estimated to have been lost due to heart disease and stroke in this population.

As expected, the seven risk factors examined explained the majority of acute heart disease and stroke events expected to occur in both Argentinean men and in women.

Of the various interventions examined, two were shown to be particularly cost-saving, namely reducing the amount of salt in bread and a modified polypill type strategy for individuals with a high absolute predicted risk for CVD over the next decade. The costs of each intervention, and cost savings to be accrued from each of the population and clinical interventions assessed, were provided in this article.

See the full series at Lancet.com www.lancet.com/series/chronic-diseases-and-development