Generalized cost-effectiveness analysis of a package of interventions to reduce cardiovascular disease in Buenos Aires,
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BioMed Central
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Generalized cost-effectiveness analysis of a package of interventions to reduce cardiovascular disease in Buenos Aires, Argentina Adolfo Rubinstein*1,2, Sebastián García Martí1, Alberto Souto1, Daniel Ferrante1 and Federico Augustovski1,2 Address: 1IECS, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina and 2Division of Family and Community Medicine, Hospital Italiano de Buenos Aires, Argentina Email: Adolfo Rubinstein* - [email protected]; Sebastián García Martí - [email protected]; Alberto Souto - [email protected]; Daniel Ferrante - [email protected]; Federico Augustovski - [email protected] * Corresponding author
Published: 6 May 2009 Cost Effectiveness and Resource Allocation 2009, 7:10
doi:10.1186/1478-7547-7-10
Received: 4 August 2008 Accepted: 6 May 2009
This article is available from: http://www.resource-allocation.com/content/7/1/10 © 2009 Rubinstein et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Chronic diseases, represented mainly by cardiovascular disease (CVD) and cancer, are increasing in developing countries and account for 53% of chronic diseases in Argentina. There is strong evidence that a reduction of 50% of the deaths due to CVD can be attributed to a reduction in smoking, hypertension and hypercholesterolemia. Generalized cost-effectiveness analysis (GCE) is a methodology designed by WHO to inform decision makers about the extent to which current or new interventions represent an efficient use of resources. We aimed to use GCE analysis to identify the most efficient interventions to decrease CVD. Methods: Six individual interventions (treatment of hypertension, hypercholesterolemia, smoking cessation and combined clinical strategies to reduce the 10 year CVD Risk) and two population-based interventions (cooperation between government, consumer associations and bakery chambers to reduce salt in bread, and mass education strategies to reduce hypertension, hypercholesterolemia and obesity) were selected for analysis. Estimates of effectiveness were entered into age and sex specific models to predict their impact in terms of age-weighted and discounted DALYs saved (disability-adjusted life years). To translate the age- and sex-adjusted incidence of CVD events into health changes, we used risk model software developed by WHO (PopMod). Costs of services were measured in Argentine pesos, and discounted at an annual rate of 3%. Different budgetary impact scenarios were explored. Results: The average cost-effectiveness ratio in argentine pesos (ARS$) per DALY for the different interventions were: (i) less salt in bread $151; (ii) mass media campaign $547; (iii) combination drug therapy provided to subjects with a 20%, 10% and 5
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