Table 45.4Comparison of the Cost-Effectiveness of Absolute Risk with Treatment According to Either Blood Pressure or Lipid Targets Alone in Addition to Population-based Strategies, Selected WHO Regions

Incremental cost-effectiveness ratio (cost/DALY saved)a
RegionStrategyRisk (percent)International $US$
Africa EPrevention (SL and/or HE)Dominatedb
Targeted risk factorscDominatedb
Absolute riskc (TRI)3513842
25778295
151,445639
Latin America and thePrevention (SL)12765
Caribbean BPrevention (SL + HE)14574
Targeted risk factorscDominatedb
Absolute riskd (TRI + SL + HE)35286178
251,5981,058
152,3911,664
54,3193,075
Southeast Asia BPrevention (SL)7018
Prevention (SL + HE)12732
Targeted risk factorscDominatedb
Absolute riskd (TRI + SL + HE)35301133
251,197578
152,0941,120
53,9522,233
Western Pacific BPrevention (SL)9718
Targeted risk factorscDominatedb
Absolute riskd (TRI + SL + HE)351,124423
251,278564
152,0921,042
54,0282,135

B = low child mortality and low adult mortality; E = high child mortality and very high adult mortality; HE = health education through the mass media to reduce cholesterol; SL = legislation to decrease the salt content of processed foods, including appropriate labeling and enforcement; TRI = treatment with aspirin, beta-blockers, and a statin.

a. Costs of prevention and nondrug costs for treatment according to absolute risk are converted at an estimated regional average ratio of exchange rate to purchasing-power parity rate; drug costs are not converted, assuming drugs to be imported at world prices. The share of drug costs in total treatment cost, as a function of risk, is taken from the estimates for India in table 45.6 and assumed to be the same for all regions.

b. Dominated strategies were both less effective and more costly than comparator strategies.

c. Treating SBP greater than 140 mmHg or 160 mmHg or total cholesterol greater than 5.7 mmol/l or 6.2 mmol/l (220 or 240 mg/dlL).

d. Risk refers to 10-year risk of CVD greater than or equal to the number listed.

From: Chapter 45, The Growing Burden of Risk from High Blood Pressure, Cholesterol, and Bodyweight

Cover of Disease Control Priorities in Developing Countries
Disease Control Priorities in Developing Countries. 2nd edition.
Jamison DT, Breman JG, Measham AR, et al., editors.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

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