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Cost-effectiveness of medical interventions to prevent cardiovascular disease in a sub-Saharan African country--the case of Tanzania.

Robberstad B, Hemed Y, Norheim OF - Cost Eff Resour Alloc (2007)

Bottom Line: There is a widespread concern that such treatment is not cost-effective compared to alternative health interventions.Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability curves and frontiers.Hydrochlorothiazide as monotherapy is the drug yielding the most favorable cost-effectiveness ratio, although not significantly lower than when it is combined in duo-therapy with Aspirin or a beta-blocker, in triple-therapy with Aspirin and a beta-blocker, or than Aspirin given as mono-therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway. bjarne.robberstad@cih.uib.no

ABSTRACT

Background: There is a high and rising prevalence of cardiovascular risk in sub-Saharan Africa, a development typical for countries in epidemiological transition. Contrary to recommendations in treatment guidelines, medical interventions to prevent cardiovascular disease are implemented only on a limited scale in these settings. There is a widespread concern that such treatment is not cost-effective compared to alternative health interventions. The main objectives of this article are therefore to calculate costs-, effects and cost-effectiveness of fourteen medical interventions of primary prevention of cardiovascular disease in Tanzania, including Acetylsalicylic acid, a diuretic drug (Hydrochlorothiazide), a beta-blocker (Atenolol), a calcium channel blocker (Nifedepine), a statin (Lovastatin) and various combinations of these.

Methods: Effect sizes were derived from systematic reviews or meta-analyses, and calculated as Disability Adjusted Life Years (DALYs). Data on drug costs were calibrated to a Tanzanian setting. Other recurrent and capital costs were derived from previous studies and reviewed by local experts. Expected lifetime costs and health outcomes were calculated using a life-cycle model. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability curves and frontiers. The potential impacts of uncertainty in value laden single parameters were explored in one-way sensitivity analyses.

Results: The incremental cost-effectiveness ratios for the fourteen interventions and four different levels of risk (totally 56 alternative interventions) ranged from about USD 85 per DALY to about USD 4589 per DALY saved. Hydrochlorothiazide as monotherapy is the drug yielding the most favorable cost-effectiveness ratio, although not significantly lower than when it is combined in duo-therapy with Aspirin or a beta-blocker, in triple-therapy with Aspirin and a beta-blocker, or than Aspirin given as mono-therapy.

Conclusion: Preventive cardiology is not cost-effective for any patient group in this setting until willingness to pay exceeds USD 85 per DALY. At this level of willingness to pay, the optimal intervention is Hydrochlorothiazide to patients with very high cardiovascular risk. As willingness to pay for health increase further, it becomes optimal to provide this treatment also to patients with lower cardiovascular risk, and to substitute to more sophisticated interventions.

No MeSH data available.


Related in: MedlinePlus

Cost-effectiveness acceptability curves for the alternative interventions in the scenario with very high CV risk.
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Figure 2: Cost-effectiveness acceptability curves for the alternative interventions in the scenario with very high CV risk.

Mentions: The uncertainty surrounding the above mean ICERs is captured by the cost-effectiveness acceptability curves in Figure 2. Some interventions have steep acceptability curves, illustrating a relatively high level of certainty. The 95% confidence interval (CI) for the ICER of Hydrochlorothiazide given to people with very high CV risk, for example, is 61 – 133 USD per DALY. Hydrochlorothiazide in combination with Aspirin have a CI of 108–197 USD per DALY relative to Hydrochlorothiazide as monotherapy.


Cost-effectiveness of medical interventions to prevent cardiovascular disease in a sub-Saharan African country--the case of Tanzania.

Robberstad B, Hemed Y, Norheim OF - Cost Eff Resour Alloc (2007)

Cost-effectiveness acceptability curves for the alternative interventions in the scenario with very high CV risk.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1808049&req=5

Figure 2: Cost-effectiveness acceptability curves for the alternative interventions in the scenario with very high CV risk.
Mentions: The uncertainty surrounding the above mean ICERs is captured by the cost-effectiveness acceptability curves in Figure 2. Some interventions have steep acceptability curves, illustrating a relatively high level of certainty. The 95% confidence interval (CI) for the ICER of Hydrochlorothiazide given to people with very high CV risk, for example, is 61 – 133 USD per DALY. Hydrochlorothiazide in combination with Aspirin have a CI of 108–197 USD per DALY relative to Hydrochlorothiazide as monotherapy.

Bottom Line: There is a widespread concern that such treatment is not cost-effective compared to alternative health interventions.Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability curves and frontiers.Hydrochlorothiazide as monotherapy is the drug yielding the most favorable cost-effectiveness ratio, although not significantly lower than when it is combined in duo-therapy with Aspirin or a beta-blocker, in triple-therapy with Aspirin and a beta-blocker, or than Aspirin given as mono-therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway. bjarne.robberstad@cih.uib.no

ABSTRACT

Background: There is a high and rising prevalence of cardiovascular risk in sub-Saharan Africa, a development typical for countries in epidemiological transition. Contrary to recommendations in treatment guidelines, medical interventions to prevent cardiovascular disease are implemented only on a limited scale in these settings. There is a widespread concern that such treatment is not cost-effective compared to alternative health interventions. The main objectives of this article are therefore to calculate costs-, effects and cost-effectiveness of fourteen medical interventions of primary prevention of cardiovascular disease in Tanzania, including Acetylsalicylic acid, a diuretic drug (Hydrochlorothiazide), a beta-blocker (Atenolol), a calcium channel blocker (Nifedepine), a statin (Lovastatin) and various combinations of these.

Methods: Effect sizes were derived from systematic reviews or meta-analyses, and calculated as Disability Adjusted Life Years (DALYs). Data on drug costs were calibrated to a Tanzanian setting. Other recurrent and capital costs were derived from previous studies and reviewed by local experts. Expected lifetime costs and health outcomes were calculated using a life-cycle model. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability curves and frontiers. The potential impacts of uncertainty in value laden single parameters were explored in one-way sensitivity analyses.

Results: The incremental cost-effectiveness ratios for the fourteen interventions and four different levels of risk (totally 56 alternative interventions) ranged from about USD 85 per DALY to about USD 4589 per DALY saved. Hydrochlorothiazide as monotherapy is the drug yielding the most favorable cost-effectiveness ratio, although not significantly lower than when it is combined in duo-therapy with Aspirin or a beta-blocker, in triple-therapy with Aspirin and a beta-blocker, or than Aspirin given as mono-therapy.

Conclusion: Preventive cardiology is not cost-effective for any patient group in this setting until willingness to pay exceeds USD 85 per DALY. At this level of willingness to pay, the optimal intervention is Hydrochlorothiazide to patients with very high cardiovascular risk. As willingness to pay for health increase further, it becomes optimal to provide this treatment also to patients with lower cardiovascular risk, and to substitute to more sophisticated interventions.

No MeSH data available.


Related in: MedlinePlus