Targeted versus universal prevention. a resource allocation model to prioritize cardiovascular prevention

Area of Science:

• Public Health
• Health Economics
• Preventive Medicine

Background:

• Diabetes mellitus significantly increases cardiovascular complication risk, necessitating preventive measures.
• Preventive strategies benefit both the general population and individuals with diabetes.
• The optimal allocation of resources between these groups is a key consideration.

Purpose of the Study:

• To determine the most effective strategy for allocating preventive healthcare resources.
• To compare the efficiency of targeting the general population versus diabetes patients for cardiovascular prevention.
• To analyze the impact of budget size on resource allocation decisions.

Main Methods:

• A mathematical programming model was employed to optimize resource allocation for interventions.
• Interventions included smoking cessation, diet/exercise for overweight, statins, and blood pressure medication.
• The model assessed total lifetime healthcare costs and Quality-Adjusted Life Years (QALYs) across varied budget sizes.

Main Results:

• Full implementation yielded 560,000 QALYs at an average cost of €12,900 per QALY, with most gains below €20,000 per QALY.
• Low or high budgets primarily benefited the general population.
• Moderate budgets were predominantly allocated to diabetes patients.

Conclusions:

• Significant health gains are achievable by implementing preventive measures in both general and diabetic populations.
• Pre-determined resource distribution is suboptimal; flexible allocation models are superior.
• Resource allocation models should consider capacity constraints and program scale alongside efficiency.