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WHO/ISH total risk approach for primary prevention of cardiovascular disease shows greater decrease in costs for
Abdullahi O Abdulkadri1, Marshall K Tulloch-Reid2, Damian K Francis2
1Department of Economics, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
Insights
Adopting a total cardiovascular risk approach for primary prevention of cardiovascular disease (CVD) offers significant cost savings, particularly for women. This shift may, however, introduce gender disparities in CVD outcomes.
Area of Science:
- Cardiovascular disease prevention
- Health economics
- Public health policy
Background:
- Current primary prevention of cardiovascular disease (CVD) often relies on single risk factor assessment.
- A comprehensive total cardiovascular risk approach may offer a more accurate and cost-effective strategy.
- Understanding the economic implications of shifting risk assessment models is crucial for healthcare planning.
Purpose of the Study:
- To evaluate the cost-effectiveness of transitioning from a single risk factor to a total cardiovascular risk approach for primary CVD prevention.
- To identify potential cost savings and economic implications associated with implementing a total risk strategy.
- To explore gender-specific cost disparities in CVD prevention.
Main Methods:
- Cost analysis utilizing data from the 2007-08 Jamaica Health and Lifestyle Survey (n=1,432, aged ≥40 years).
- 10-year CVD risk estimation using World Health Organization/International Society for Hypertension (WHO/ISH) risk charts.
- Incorporation of WHO/ISH and local treatment guidelines to cost lifestyle modifications, pharmacotherapy, and healthcare provider visits.
Main Results:
- The total cardiovascular risk approach demonstrated lower costs across all age groups compared to single risk assessment.
- Significant cost disparities were observed, with women experiencing greater potential savings.
- Estimating 10-year CVD risk without measured cholesterol led to similar costs for both approaches in men aged 60 years and older.
- Annual per capita costs for lifestyle recommendations (diet: $869.05, physical activity: $80) represent a substantial portion of minimum wage income.
- National implementation of the WHO/ISH total risk approach could yield annual healthcare cost reductions of approximately $5 million.
Conclusions:
- The shift to a total cardiovascular risk approach presents considerable cost savings, primarily driven by reduced healthcare utilization in women.
- These cost savings, however, may inadvertently create or exacerbate gender disparities in CVD outcomes.
- Further research is needed to address potential gender-specific impacts and ensure equitable CVD prevention strategies.
Objectives:
To investigate cost savings from and implications of replacing the single risk with a total cardiovascular risk approach in primary prevention of cardiovascular disease (CVD).
Study Design And Setting:
A cost analysis using data from the 2007-08 Jamaica Health and Lifestyle Survey of 1,432 persons aged 40 years and older with 10-year risk estimated from region-specific World Health Organization/International Society for Hypertension (WHO/ISH) CVD risk charts. The WHO/ISH and local treatment guidelines were used to cost lifestyle changes, medications, and provider visits.
Results:
Use of the total cardiovascular risk approach was less costly regardless of age. Women showed greater cost disparity. However, if 10-year CVD risk was estimated without measured cholesterol, both approaches resulted in similar costs in men ≥60 years. The annual per capita cost of lifestyle recommendations, critical in the absence of pharmacotherapy, was estimated at US $869.05 for diet and US $80 for physical activity. This represents about a third of the annual income of a minimum wage earner. At the national level, implementation of the WHO/ISH total risk approach could reduce health care costs by US $5 million annually.
Conclusion:
Cost savings that mainly resulted from reduced care for women may lead to gender disparity in CVD outcomes.
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