Background
Methods
Eligibility criteria
Information sources
Search strategy
Study selection
Data collection process
Data items
Risk of bias in individual studies (Quality review)
Synthesis of results
Risk of bias across studies
Results
Study selection
Study characteristics
Intervention | Different effects of intervention used | Effect estimates used within individual studies | Source of effect estimate-trial type and principal* source | |
---|---|---|---|---|
Pharmacological interventions
| Polypill | Reduced absolute risk CVD | −20% [15] | Meta analysis [16] |
Reduced relative risk of CVD | RR=0.12 [17] for cardiovascular disease | Estimate based on RCT evidence [2] | ||
RR=0.29 for IHD and 0.4 for stroke (primary prevention) [18] | Overview of RCTs [19] | |||
RR=0.12 for CHD and RR=0.2 for stroke [20] | ||||
Reduction in BP and cholesterol + reduced absolute risk (to account for effects of aspirin) | 20% reduction in cholesterol+33% reduction in difference in BP between 115** and current + 20% reduction absolute risk CVD (to account for benefits aspirin) [23] | Product of estimates from RCT estimates used for Cholesterol and BP. For Aspirin [16] | ||
20% reduction in cholesterol+28% reduction in difference in BP between 115** and current + 18% reduction absolute risk CVD (to account for benefits aspirin) [24] | Product of estimates from RCT estimates used for Cholesterol and BP. For Aspirin [16] | |||
Treatment of “high“cholesterol | Reduction in total serum cholesterol concentration | −20% [15]) | RCT [21] | |
−20% [23] | RCT [21] | |||
−22% [25]) | RCT [26] | |||
Reduction in relative risk of cardiovascular disease | RR=0.84 [20] | Heart Protection Study Group [21]. | ||
RR=0.95 [17] | Meta analysis [27] | |||
Treatment of “high” BP | Reduction in relative risk of disease | RR=0.82 [17] | Overview of RCTs [28] | |
RR=0.66 for stroke, RR=0.72 for CHD [20] | Overview of RCTS. [22] | |||
Reduction in the difference between SBP & 115 mmHg | −33% reduction [15] | Overview of RCTs [19] | ||
−33% reduction [23] | RCT [29] | |||
Blood pressure lowering | 10 mmHg lowering of BP, yielding 40% RR reduction stroke and 14% reduction for coronary heart disease. [30]. | Overview of randomised trials [19] | ||
Tobacco control
| Mass media smoking | Reduction in smoking prevalence | −2% [24]) | Observational. Friend and Levy. 2002 [31]. |
−1.5%[15] | Review of observational data [31] | |||
Price increase cigarettes | Reduction smoking attributable death | 5-15% [32] | Review of observational data [33] | |
Nicotine replacement therapy (gum) | Increased likelihood of cessation | OR=1.66 [34] | Systematic review [35] | |
Increase in percentage using NRT who quit | 5% [24] | |||
Community pharmacist smoking cessation | Increase in proportion using cessation services who become long term quitters | 14.3% continuous quit rate compared to 2.7 if usual care [36]. | RCT [37] | |
Bupropion-smoking cessation | Reduced relative risk of CVD | RR=0.8 [17] | Systematic review [38] | |
Mass media interventions
| Mass media, diet/cholesterol | Reduced total serum cholesterol | −2% [15] | Cost effectiveness analysis [39] |
−2% [23] | Cost effectiveness analysis [39] | |||
Mass media salt/reductions food | Reduced total dietary salt intake | −20% (range 10-30%) [24] | Effect of salt on BP from meta analysis [40] Mass media effects not supported. | |
−15% [15] | No reference for impact on salt intake, impact of salt reduction on BP from trial data [41] | |||
Reduced CVD prevalence | −4% [32] | Review [14] and expert opinion | ||
Combined mass media | Relative risk of CVD | RR=0.98 [17] | Meta analysis [42] | |
Legislative Interventions
| Salt in bread-voluntary/other | Reduced CVD relative risk | RR=0.99 [17] | No reference for impact of legislation, review of trials supports impact of salt on CVD [43] |
Legislation on salt in food | Reduction in total dietary salt intake | 30% reduction [23] | No reference for impact of legislation. Impact of salt on BP from observational data [44] | |
Reduced salt intake via legislation + education | Reduced systolic BP | −2 mmHg (1-4) mmHg [32] | Review [14] and expert opinion | |
Reduction in the difference between actual SBP & 115 mmHg | 33% reduction [15] |
Results of individual studies
Tobacco control
Pharmacological primary prevention using an absolute risk based approach
Individual risk factor reduction approach
Use of mass media
Other legislative interventions
Provenance of studies and study estimates of costs and effects
Authors, year and title | Setting | Intervention/s | Main economic findings (outcome metric) | Target population | Quality score (Drummond) | In overall summary (Figure 2) |
---|---|---|---|---|---|---|
Huang Guangyong et al., 2000 [45] Cost effectiveness of the Beijing Fangshan cardiovascular prevention programme | China | Health education and anti-hypertensive drugs | Intervention found to be cost effective | Initially whole population, then high risk | +/− | No –limited comparability |
Gaziano et al., 2007 [18] Cardiovascular disease prevention with a multidrug regimen in the developing world | 6 World Bank Regions | Fixed dose combination therapy | Found cost effective in all world regions for primary and secondary prevention | Various | + + | Yes |
Caro et al. 1999 [25] International economic analysis of primary prevention of cardiovascular disease with Pravastatin in WOSCOPS | South Africa | Pravastatin for primary prevention | Authors describe Pravastatin as efficient for CVD primary prevention. Note, cost per LYG close to 3 X GNI per capita for study year. Thus cost/DALY likely to be > 3 X GNI/Capita | Men with high cholesterol | + | Yes |
Rubinstein et al., 2009 [17] Generalised cost effectiveness analysis of a package of interventions to reduce cardiovascular disease in Buenos Aires, Argentina | Argentina | Personal pharmacological and non personal population-based interventions | All interventions cost effective with exception of statins to lower “high” cholesterol | Various | + + | Yes |
Anh Ha and Chisholm, 2010 [24] Cost effectiveness of intervention to prevent cardiovascular disease in Vietnam | Vietnam | Personal pharmacological and non personal population-based interventions. | Range of interventions judged cost effective and deliverable at low cost | Various | + + | Yes |
Gaziano et al., 2005 [30]. Cost effectiveness analysis of hypertension guidelines in South Africa | South Africa | Antihypertensive drugs | Absolute risk based initiation of therapy dominated a strategy of initiating medications based on blood pressure threshold alone | Hypertensive/high CVD risk. | + + | Yes |
Schuffham et al., 2006 [47]. The cost effectiveness of Fluvastatin in Hungary Following Successful PCI | Hungary | statins | Judged to be cost effective | Post PCI patients | +/− | No-limited generalisability |
Gilbert et al., 2004 [34]. The cost effectiveness of pharmacological smoking cessation therapies in developing countries | Seychelles | Smoking cessation | Shown to be cost effective but affordability in LMIC settings questioned given high cost | Smokers | + | Yes |
Robberstad et al., 2007 [20]. Cost effectiveness of medical interventions to prevent cardiovascular disease in a Sub-Saharan African country | Tanzania | Pharmaco-prevention including the polypill | Some interventions judged cost effective but affordability in this setting questioned | Those over age 45 | + | Yes |
Redekop et al., 2008 [46]. Costs and effects of secondary prevention with Perindopril in Stable Coronary Heart Disease in Poland | Poland | ACE inhibitos for secondary prevention | Authors report high probability for Perindopril effectiveness in secondary prevention. Using reported results against WHO criteria we find not cost effective – not study conclusions | Those with existing CHD | +/- | Yes |
Thavorn et al., 2007 [36]. A cost effectiveness analysis of a community pharmacist-based smoking cessation programme in Thailand | Thailand | Nicotine replacement therapy | Authors find intervention to be cost saving. (cost/LYG) | Regular smokers | + | Yes |
Araujo et al., 2007 [48]. Cost effectiveness and budget impact analysis of Rosuvastatin and Atorvastatin for LDL cholesterol and cardiovascular events lowering within the SUS scenario | Brazil | Branded statin | Rosuvasctatin found to be more cost effective than Atorvastatin | Those at high risk of CVD | - | No-comparison of 2 drugs of same class |
Akkazieva et al., 2009 [15]. The health effects and costs of the interventions to control cardiovascular disease in Kyrgyzstan | Kyrgyzstan | Pharmacological and non personal population-based interventions | Wide range of cost effectiveness between interventions. Blood pressure lowering drugs and mass media most cost effective | Variable | + + | Yes |
Murray et al., 2003 [23]. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol | 6 world bank regions | Pharmacological and non personal population-based interventions | Non personal interventions found to be most cost effective. Absolute risk based approach also found to be cost effective | Various | ++ | Yes |
6 world bank regions | Pharmacological and non personal population-based interventions. | Tobacco control interventions, salt reduction and multidrug therapy on the basis of absolute risk approach likely to be cost effective in most settings. | Various | ++ | Yes | |
WHO regions | Personal and non personal interventions for tobacco control | Most interventions cost effective, non personal interventions such as taxation and legislation far more so than personal interventions such as NRT. | Smokers | ++ | Yes |