Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study.

BMJ. 2011 Jul 28;343:d4044. doi: 10.1136/bmj.d4044. Barton P, Andronis L, Briggs A, McPherson K, Capewell S. Health Economics Unit, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK

OBJECTIVE: To estimate the potential cost effectiveness of a population-wide risk factor reduction programme aimed at preventing cardiovascular disease.

DESIGN: Economic modelling analysis.

SETTING: England and Wales. Population Entire population. Model Spreadsheet model to quantify the reduction in cardiovascular disease over a decade, assuming the benefits apply consistently for men and women across age and risk groups.

MAIN OUTCOME MEASURES: Cardiovascular events avoided, quality adjusted life years gained, and savings in healthcare costs for a given effectiveness; estimates of how much it would be worth spending to achieve a specific outcome.

RESULTS: A program across the entire population of England and Wales (about 50 million people) that reduced cardiovascular events by just 1% would result in savings to the health service worth at least £30m (€34m; $48m) a year compared with no additional intervention. Reducing mean cholesterol concentrations or blood pressure levels in the population by 5% (as already achieved by similar interventions in some other countries) would result in annual savings worth at least £80m to £100m. Legislation or other measures to reduce dietary salt intake by 3 g/day (current mean intake approximately 8.5 g/day) would prevent approximately 30,000 cardiovascular events, with savings worth at least £40m a year. Legislation to reduce intake of industrial trans fatty acid by approximately 0.5% of total energy content might gain around 570,000 life years and generate NHS savings worth at least £230m a year.

CONCLUSIONS: Any intervention that achieved even a modest population-wide reduction in any major cardiovascular risk factor would produce a net cost saving to the NHS, as well as improving health. Given the conservative assumptions used in this model, the true benefits would probably be greater.

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