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Circ Cardiovasc Qual Outcomes. 2015 Nov;8(6):541-51. doi: 10.1161/CIRCOUTCOMES.115.001994. Epub 2015 Nov 10.

Health and Economic Implications of National Treatment Coverage for Cardiovascular Disease in India: Cost-Effectiveness Analysis.

Author information

1
From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.). basus@stanford.edu.
2
From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.).

Abstract

BACKGROUND:

Whether to cover cardiovascular disease costs is an increasingly pressing question for low- and middle-income countries. We sought to identify the impact of expanding national insurance to cover primary prevention, secondary prevention, and tertiary treatment for cardiovascular disease in India.

METHODS AND RESULTS:

We incorporated data from coverage experiments into a validated microsimulation model of myocardial infarction and stroke in India to evaluate the cost-effectiveness of alternate coverage strategies. Coverage of primary prevention alone saved 3.6 million disability-adjusted life-years (DALY) per annum at an incremental cost-effectiveness ratio of $469 per DALY averted when compared with the status quo of no coverage. Coverage of primary and secondary preventions was dominated by a strategy of covering primary prevention and tertiary treatment, which prevented 6.6 million DALYs at an incremental cost-effectiveness ratio of $2241 per DALY averted, when compared with that of primary prevention alone. The combination of all 3 categories yielded the greatest impact at an incremental cost per DALY averted of $5588 when compared with coverage of primary prevention plus tertiary treatment. When compared with the status quo of no coverage, coverage of all 3 categories of prevention/treatment yielded an incremental cost-effectiveness ratio of $1331 per DALY averted. In sensitivity analyses, coverage of primary preventive treatments remained cost-effective even if adherence and access to therapy were low, but tertiary coverage would require avoiding unnecessary procedures to remain cost-effective.

CONCLUSIONS:

Coverage of all 3 major types of cardiovascular treatment would be expected to have high impact and reasonable cost-effectiveness in India across a broad spectrum of access and adherence levels.

KEYWORDS:

cost-effectiveness; developing countries; health policy; healthcare economics and organizations; insurance; myocardial infarction; stroke

PMID:
26555122
PMCID:
PMC4801228
DOI:
10.1161/CIRCOUTCOMES.115.001994
[Indexed for MEDLINE]
Free PMC Article

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