Table 2 Summary of studies included
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 |
Disease Control Priorities Project * [32, 49] Chapters 44: Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. 45: Blood Pressure, Cholesterol and Bodyweight, 46: Tobacco Addiction. | 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 + Chisholm *[5, 12] Comparative cost effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. | 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 |