ESTIMATION OF THE BURDEN OF CARDIOVASCULAR DISEASE ATTRIBUTABLE TO MODIFIABLE RISK FACTORS AND COST-EFFECTIVENESS ANALYSIS OF PREVENTIVE INTERVENTIONS TO REDUCE THIS BURDEN IN ARGENTINA

Author(s)

Rubinstein A1, Colantonio L2, Bardach A2, Caporale JE1, Garcia Marti S2, Gibbons L3, Kopitowski K4, Alcaraz A5, Augustovski FA1, Pichon-Riviere A61Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina, 2Instituto de Efectividad Clínica y Sanitaria (IECS), Ciudad de Buenos Aires, Buenos Aires, Argentina, 3Institute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, 4Servicio de Medicina Familiar y Comunitaria, Buenos Aires, Argentina, 5Intitute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, 6Instituto de Efectividad Clínica y Sanitaria (IECS), Ciudad Autónoma de Buenos Aires, Argentina

OBJECTIVES Chronic diseases account for 50% of the burden of disease (BoD) in Argentina, and cardiovascular diseases (CVD) represent 30% of deaths and 13% of YLL. The aim of this study was to develop a model to estimate the burden of CVD attributable to risk factors (RF), costs, and cost-effectiveness (CE) of different interventions to reduce CVD METHODS Selected CVRF(high blood pressure (HBP), high cholesterol, high glycemia, overweight, smoking, sedentary style, and unhealthy diet), were taken from each of the 50,000 individuals included in the Argentine Risk Factor Survey database, and entered into a simulation model with their relative risks for coronary heart disease and stroke. Six individual interventions (treatment of HBP, hypercholesterolemia, smoking cessation and polypill-like therapy to 3 different risk groups) and two population interventions (reduction of salt in bread and media campaign against tobacco) were selected. Estimates of effectiveness of the interventions were used to predict their impact in DALY's saved. Costs of acute CHD and stroke events were measured in Argentine pesos. ICERs were discounted at an annual rate of 3%. Probabilistic sensitivity analysis and acceptability curves were used as needed RESULTS More than 80% of the events were attributable to these selected CVRF. Two interventions were cost-saving: reducing salt in bread and polypill treatment to high CV risk subjects, the latter with a reduction of 5% of BoD. Two interventions had acceptable ICER: HBP treatment ($4509/DALY saved) and anti-tobacco campaign ($4939/DALY saved). Cholesterol lowering with atorvastatin ($61,000/DALY saved) and tobacco-cessation with bupropion ($92,000/DALY saved), showed less favorable ICER. CONCLUSIONS Most of these interventions seem to be feasible and cost-effective. Taking into account that CVD is the leading cause of BoD in Argentina, interventions to reduce it should be prioritized. This model aims to help policy makers to make informed resource-allocation decisions to reduce CVD in Argentina.

Conference/Value in Health Info

2009-09, ISPOR Latin America 2009, Rio de Janeiro, Brazil

Value in Health, Vol. 12, No. 7 (October 2009)

Code

CS9

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Cardiovascular Disorders

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