Cardiology: Cardiac Prevention is Effective and Cost-Effective

The high direct and indirect costs of cardiovascular care make this a critical medical and societal issue

A policy statement from the American Heart Association that was published recently on the Circulation website says that prevention of heart disease is effective and cost-effective. A review of cost-effectiveness analyses showed that interventions aimed at limiting salt consumption, ending tobacco use, encouraging physical activity, and improving diet prevent cardiovascular events, but also provide value (are worth what we pay for them) and save money.

Although it is well established in clinical trials that prevention works, it is less well established that prevention programs in communities are effective and provide value. A key problem is the long time frames necessary to evaluate these programs, which can lead to flaws in cost-effectiveness analyses. Analyses such as these are crucial, however, because direct and indirect costs of cardiovascular disease were close to $450 billion in 2010 and could rise to more than $1 trillion by 2030. The authors thus reviewed the available evidence regarding prevention and cost-effectiveness. Findings included:

• Community-based programs to increase physical activity, improve nutrition, and prevent smoking would return $5.60 for every dollar spent within five years;
• Comprehensive worksite wellness programs result in medical costs falling by about $3.27 for every dollar spent in the first 12 to 18 months and absenteeism costs falling by about $2.73 for every dollar spent;
• School-based initiatives to promote healthy eating and physical activity result in a cost-effectiveness of between $900 and $4,305 per quality of life year (QALY) saved;
• Building bike and pedestrian trails saves nearly $3 for every dollar spent;
• Physical activity interventions such as pedometer and walking programs have an incremental cost-effectiveness ratio between $14,000 and $69,000 per every QALY gained;
• Reducing population sodium intake to 1,500 mg per day would result in annual healthcare savings of $26.2 billion;
• One-year interventions for obesity prevention have shown reduction in risk categories such as poor eating/poor physical activity habits, and weight for a return on investment of $1.17 for every dollar spent;
• Full adherence to ATP III primary prevention guidelines would prevent 20,000 myocardial infarctions and 20,000 cardiovascular deaths at a total cost of $3.6 billion for $42,000 per QALY (assuming low-intensity statins cost $2.11 per pill); and
• Hypertension medication therapy would offer approximately $37,000 cost per life-year saved.

“Cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost-saving compared with common benchmarks,” the authors write.

Source: Weintraub WS, Daniels SR, Burke LE, et al. 2011. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Published on July 25, 2011 on the Circulation website.