OBJECTIVES: The cost-effectiveness of community based cardiovascular disease (CVD) risk-reduction interventions for older adults in residential settings is not well established. Support and Services at Home (SASH) is an intervention designed to reduce modifiable CVD risk factors through improved medication management and behavioral interventions. This program has previously demonstrated success, but the cost-effectiveness is unknown. Community based interventions for older, high-risk population are potentially attractive complements to healthcare delivery a lower cost relative to medical care and may be attractive in rural settings with limited clinical resources.

METHODS: SASH performed screenings and provided ongoing participant support within predominantly rural communities. We calculated quality-adjusted life years (QALYs) gained and program costs using a Markov model. Transition probabilities were calculated using Framingham risk equations or derived from the literature using the observed mean reduction in 10-year CVD risk score over of 24 months follow-up. Program cost-effectiveness was calculated for both at-risk (abnormal baseline CVD risk factors) and overall program populations. Costs and benefits were discounted at r=3%.

RESULTS: The base-case scenario evaluating a 75-year-old male participant revealed an incremental cost savings of $4320 and a gain of 0.33 QALYs associated with the intervention. Cost savings were greater in at-risk populations. The economic dominance of the model was robust in multiple sensitivity analyses.

CONCLUSIONS: This interventions targeted at high-risk community-based residential older individuals to reduce CVD risk is cost-effective. They key elements were the improved use of medications and reductions in smoking rates. This suggests that population-based public health programs may have the potential to complement primary care preventative services to improve health and reduce the burden of traditional medical care.