Low income, developing, and developed countries have shown that chronic disease interventions, such as tobacco control programs, salt reduction plans, and multidrug regimens for high-risk cardiovascular disease patients are cost effective and should be increased, according to Dr Thomas Gaziano, Brigham & Women’s Hospital, Harvard Program for Health Division Science, Boston, MA, USA, and team, authors of the second paper in The Lancet’s Chronic Diseases Series.
According to the writers, further studies to determine the best national policies that get people to consume less saturated and trans fats could eventually lead to significant reductions in cardiovascular disease. The Series also looks at lifestyle changes, health systems, and policy decisions – analyzing them with regards to their successes and cost effectiveness.
A good example of community intervention is the North Karelia project, which started in Finland in 1972. It included health education, screening, blood pressure control, and treatment. Within five years coronary heart disease mortality dropped by 2.9% annually, compared to 1% in the rest of the country.
In the early 1990s Polish authorities lowered subsidies on lard and butter, which triggered a consumer switch to polyunsaturated oils, such as soybean and rapeseed. Within twelve years coronary heart disease mortality fell by over 25%.
In developing nations the cost-effectiveness of the intervention of salt reduction following public education programs are positive, ranging from being cost saving to US$200 per disability life year (DALY) averted; tobacco programs have comparable outcomes, with measures such as increased pricing/taxation coming in at US$100 per DALY averted.
Coronary heart disease incidence can be reduced by 7-8% if 2% of energy from trans fats is replaced with polyunsaturated fat, according to analyses from the Disease Control Priorities Project. This can be achieved at less than $0.50 per head, says the FDA, if such changes are facilitated through voluntary action by the food industry or by legislation, as was the case in New York where trans fats in restaurants were barred. “With this cost and the conservative estimate of an 8% reduction in coronary heart disease, the intervention is highly cost effective at $25 – 75 per DALY averted across the developing world. Assuming the greater reduction of 40% in coronary heart disease, the intervention is cost saving,” say the writers.
“There is clear evidence that many interventions are cost effective. The Commission on Macroeconomics and Health has proposed a standard of three times gross national income (GNI) per head per DALY averted as being cost-effective. The World Bank estimates that GNI per head in 2006 was, on average, $650 for low-income countries and $3051 for middle-income countries. Tobacco interventions, salt reductions, and multidrug strategies to treat individuals with high-risk cardiovascular disease have acceptable cost-effectiveness ratios for low-income and middle-income countries on the basis of this criterion. If scale-up is feasible for many nations, then it would be reasonable to pursue these options immediately to achieve the projected goals of reducing rates of chronic disease by an additional 2% per year,” the authors conclude.
Written by – Christian Nordqvist