OBJECTIVES: Worldwide cardiovascular disease (CVD) morbidity and mortality trends induces high direct and indirect costs. We propose an innovative approach entailing a societal and macroeconomic perspective to assess value creation of health investments to reduce CVD burden and promote economic growth within the country: the Health ROI Assessor framework. It is operationalized in a measurement tool and applied to a real-world prevention program in Estonia. The intervention provides a tailored solution to reduce low-density lipoprotein cholesterol and related CVD risk at the population level (age 30 to 79, without CVD history).

METHODS: The framework includes two pillars: 1. The Health Economy (HE) Footprint estimates direct effects within the HE (Gross Value-Added and corresponding job creation) and spillovers to other economic sectors (indirect/induced effects); 2. The Human Capital Effect evaluates avoided productivity losses related to better health outcomes. Model inputs include age-, gender- and risk-specific previously estimated avoided CV events (i.e., Markov Model implemented in a separate project), which could be derived from the Estonian intervention program. Labor-market interaction connects both pillars via labor-force supply/demand adjustments. Time series analysis allows us to build a dynamic framework of health investments. The implementation is based on health and economic data from official statistics.

RESULTS: Results for Estonia suggest that each additional €1 Mio invested in CVD prevention creates €2.1 Mio of value in the HE and along the supply chain and 46 additional jobs within the first three years. The Human Capital Effect pillar indicates that the 350 non-fatal and 93 fatal avoided CVD events predicted for the first ten years translate into 0.9 million hours of gained productivity, representing €32.2 Mio (€18.8 Mio paid and €13.4 Mio unpaid work).

CONCLUSIONS: Our results support policy decisions to improve preventive resource allocation, make healthcare systems sustainable and incentivize economic growth.