Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and costeffectiveness analysis of preventive interventions to reduce this burden in Argentina

RUBINSTEIN, A; COLANTONIO, LISANDRO; BARDACH, ARIEL; CAPORALE J; GARCIA MARTÍ, SEBASTIAN; GIBBONS, LUZ; KOPITOWSKI, K; ALCARAZ A; AUGUSTOVSKI, F; PICHON-RIVIERE A,

Congreso; ISPOR 12th Annual European Congress Paris France.; 2009

ISPOR

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.