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

Abstract

BackgroundCardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions.MethodsAn epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years.ResultsAn estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved)ConclusionsMost of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.

The Economic Impact of Dietary Sodium Reduction In Canada

“…The Cardiovascular Disease Policy Model (CVDPM) has been used in the United States, China and Argentina to determine the cost-effectiveness of population level sodium reduction (91)(92)(93). In the United States dietary salt reduction of 3 g/day (1200 mg/day sodium) was estimated to save 194,000 to 392,000 QALYs and $10 billion to $24 billion dollars annually (91)(92)(93).…”

“…In the United States dietary salt reduction of 3 g/day (1200 mg/day sodium) was estimated to save 194,000 to 392,000 QALYs and $10 billion to $24 billion dollars annually (91)(92)(93). In Argentina, dietary sodium reduction of 319-387 mg/day would avert 1900 deaths, 13,000 myocardial infractions, and 10 000 total strokes.…”

Monitoring the cluster of high-risk mortality areas in the southwest of Spain

“…mapping childhood cancer or occupational cancers) or quality of life indicators designed to quantify the burden of disease, (e.g. estimating the disability-adjusted life years (DALYs World Bank, 1993;Murray and Lopez, 1996;Rubinstein et al, 2010). However, this type of information is still not available in Spain neither at the provincial nor the municipal level.…”

Designing low-cost “heart healthy bread”: optimization using linear programing and 15-country comparison

“…For example, a number of European governments aim to reduce sodium intakes by regulating the maximal level of sodium in bread [7,8]. This action is supported by various modeling studies that suggest both health and economic advantages of reducing sodium in bread (e.g., for Argentina [9][10][11], Australia [12,13], New Zealand [14] and South Africa [15]). Furthermore, there have been successful studies and interventions to replace sodium chloride in bread with potassium salts [16][17][18].…”