Extended Cost-Effectiveness Analyses of Cardiovascular Risk Factor Reduction Policies

Excerpt

Recent improvements in prevention and treatment have led to marked reductions in age-standardized mortality rates from cardiovascular disease (CVD) in low- and middle-income countries (LMICs). However, because of rapid population growth and aging in these countries, the number of fatal and nonfatal cases of CVD continues to rise (Roth and others 2015). This increase in the absolute burden of CVD is accompanied by an increase in the economic impact of CVD that includes financial risks related to accessing treatment (Bloom and others 2011; Jha and others 2013). The findings from a systematic review indicate incidence of catastrophic health expenditure (CHE) of greater than 70 percent in patients with CVD or stroke in China, India, and Tanzania, and 68 percent in patients with cancer (Huffman and others 2011).

CVD and its risk factors are frequently distributed across populations in different ways. A popular notion is that CVD is a condition of older, urban males; however, evidence suggests that younger individuals in poorer and rural areas are often disproportionately affected (Gaziano 2009). Furthermore, recent studies have shown that the poorest countries and world regions have the highest incidence and case-fatality ratios from CVD, compared with the wealthiest areas. This observation could be due in part to disparities in access to health services in general and evidence-based interventions in particular (Yusuf and others 2014).

Extended cost-effectiveness analysis (ECEA) is a new economic evaluation method developed as part of the Disease Control Priorities Network grant funded by the Bill & Melinda Gates Foundation and the Disease Control Priorities, 3rd edition (DCP3, http://www.dcp-3.org). The rationale for ECEA is to extend the scope of cost-effectiveness analysis (CEA) to assess health policies more adequately. CEA centers on the summary metric of incremental cost-effectiveness—cost per amount of health gained—and is a key part of health technology assessment.

ECEA goes beyond simply measuring health outcomes to estimate incremental gains in nonhealth outcomes that are important to health systems, such as financial risk protection (FRP) and distributional consequences like equity and fairness (Verguet, Laxminarayan, and Jamison 2015). ECEA results are usually presented in “dashboard” format, that is, disaggregated into health and nonhealth outcomes per dollar spent on a particular health policy and estimated separately for different socioeconomic groups. ECEA is well designed to respond to the policy questions posed in the World Health Reports of 2010 and , specifically, how to move efficiently to universal health coverage (UHC) (WHO 2010, 2013).

This chapter summarizes lessons learned from three ECEAs that have been conducted on CVD risk factor reduction policies for DCP3. Specifically, it highlights new insights that these ECEAs have provided into the differential impacts of well-established CVD prevention interventions. It also identifies priority issues for future ECEAs to address, and draws some conclusions and implications for public health policy.