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Cost-effectiveness and budget impact analysis of screening and preventive interventions for cardiovascular disease in
Zin Mar Win1, Wenhui Mao2,3, Tom Traill1
1Community Partners International (CPI), Yangon, Myanmar.
Insights
Implementing comprehensive cardiovascular disease (CVD) prevention strategies, including screening, primary, and secondary prevention, is cost-effective for reducing CVD deaths in Myanmar. Increased investment in these services is crucial for better public health outcomes.
Area of Science:
- Public Health
- Health Economics
- Cardiovascular Disease Prevention
Background:
- Cardiovascular diseases (CVD) are a leading cause of mortality in Myanmar.
- Insufficient government and donor funding for CVD preventive services contributes to poor health outcomes.
Purpose of the Study:
- To conduct a cost-effectiveness and budget impact analysis of WHO-recommended CVD prevention strategies in Myanmar.
- To provide evidence for increased investment in CVD prevention services.
Main Methods:
- A Markov model was utilized to analyze costs and quality-adjusted life years (QALYs) from both healthcare provider and societal perspectives.
- Transition probabilities were derived from WHO CVD risk data, with treatment effects and costs sourced from secondary data.
- Budget impact analysis assessed the affordability of implementing CVD preventive care from a healthcare provider viewpoint.
Main Results:
- The most cost-effective strategy varied by threshold: combination screening, primary, and secondary prevention (Sc-PP-SP) at 3x GDP per capita (ICER: $1574/QALY), and secondary prevention alone at 1x GDP per capita (ICER: $160/QALY).
- From a societal perspective, Sc-PP-SP was most cost-effective (ICER: $647/QALY).
- Intervention at age 45 was optimal for both sexes. The Sc-PP-SP strategy could avert 55,000 acute CVD events and 28,000 deaths in the first year, costing $157 million.
Conclusions:
- A combined approach of screening, primary, and secondary prevention is a cost-effective method to decrease CVD-related mortality in Myanmar.
- Study findings support increased investment and resource allocation for CVD prevention by government and development partners.
- Adopting a total cardiovascular risk approach aligns with global health goals and enhances CVD prevention efficiency.
Background:
Cardiovascular diseases (CVD) remains a leading cause of mortality in Myanmar. Despite the burden, CVD preventive services receive low government and donor budgets, which has led to poor CVD outcomes.
Methods:
We conducted a cost-effective analysis and a budget impact analysis on CVD prevention strategies recommended by the WHO. A Markov model was used to analyse the cost and quality-adjusted life year (QALY) from healthcare provider and societal perspectives. We calculated transition probabilities from WHO CVD risk data and obtained treatment effects and costs from secondary sources. Subgroup analysis was performed on different sex and age groups. We framed the budget impact analysis from a healthcare provider perspective to assess the affordability of providing CVD preventive care.
Findings:
The most cost-effective strategy from the healthcare provider perspective varied. The combination of screening, primary prevention, and secondary prevention (Sc-PP-SP) (incremental cost-effectiveness ratio [ICER]: US$1574/QALY) is most cost-effective at the three times gross domestic product (GDP) per capita threshold, while at one time the GDP per capita threshold, secondary prevention is the most cost-effective strategy (ICER: US$160/QALY). Sc-PP-SP is the most cost-effective strategy from the societal perspective (ICER: US$647/QALY). Among age groups, intervention at age 45 years appeared to be the most cost-effective option for both men and women. The budget impact revealed the Sc-PP-SP would avert 55,000 acute CVD events and 28,000 CVD-related deaths with a cost of US$157 million for the first year of CVD preventive care.
Interpretation:
A combination of screening, primary prevention, and secondary prevention is cost-effective to reduce CVD-related deaths in Myanmar. This study provides evidence for the government and development partners to increase investment in and support for CVD prevention. These findings not only provide a basis for efficient resource allocation but also underscore the importance of adopting a total cardiovascular risk approach to CVD prevention, in alignment with global health goals.
Funding:
Pilot grant from Duke Global Health Institute, USA.
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