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Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis.

Tolla, MT ; Norheim, Ole F. ; Memirie, ST ; Abdisa, SG ; Ababulgu, A ; Jerene, Degu LU ; Bertram, M ; Strand, K ; Verguet, S and Johansson, KA (2016) In Cost Effectiveness and Resource Allocation 14. p.1-14
Abstract
Background
The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia’s meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper’s objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting.
Methods
Fifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization’s Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and... (More)
Background
The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia’s meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper’s objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting.
Methods
Fifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization’s Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and price of traded and non-traded goods. Costs and health benefits were discounted at 3 % per year. Incremental cost-effectiveness ratios are reported in US$ per disability adjusted life year (DALY) averted. Sensitivity analysis was undertaken to assess robustness of our results.
Results
Combination drug treatment for individuals having >35 % absolute risk of a CVD event in the next 10 years is the most cost-effective intervention. This intervention costs US$67 per DALY averted and about US$7 million annually. Treatment of acute myocardial infarction (AMI) (costing US$1000–US$7530 per DALY averted) and secondary prevention of IHD and stroke (costing US$1060–US$10,340 per DALY averted) become more efficient when delivered in integrated packages. At an annual willingness-to-pay (WTP) level of about US$3 million, a package consisting of aspirin, streptokinase, ACE-inhibitor and beta-blocker for AMI has the highest probability of being most cost-effective, whereas as WTP increases to > US$7 million, combination drug treatment to individuals having >35 % absolute risk stands out as the most cost-effective strategy. Cost-effectiveness ratios were relatively more sensitive to halving the effectiveness estimates as compared with doubling the price of drugs and laboratory tests.
Conclusions
In Ethiopia, the escalating burden of CVD and its risk factors warrants timely action. We have demonstrated that selected CVD intervention packages could be scaled up at a modest budget increase. The level of willingness-to-pay has important implications for interventions’ probability of being cost-effective. The study provides valuable evidence for setting priorities in an essential healthcare package for CVD in Ethiopia. (Less)
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author
; ; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
in
Cost Effectiveness and Resource Allocation
volume
14
article number
10
pages
1 - 14
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85007470723
ISSN
1478-7547
DOI
10.1186/s12962-016-0059-y
project
LUC3 - Lund University Child Centered Care
language
English
LU publication?
no
id
4c995e5d-6b92-4d11-a6fe-3404d963dc74
date added to LUP
2019-06-28 10:45:38
date last changed
2022-04-10 19:17:31
@article{4c995e5d-6b92-4d11-a6fe-3404d963dc74,
  abstract     = {{Background<br>
The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia’s meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper’s objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting.<br>
Methods<br>
Fifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization’s Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and price of traded and non-traded goods. Costs and health benefits were discounted at 3 % per year. Incremental cost-effectiveness ratios are reported in US$ per disability adjusted life year (DALY) averted. Sensitivity analysis was undertaken to assess robustness of our results.<br>
Results<br>
Combination drug treatment for individuals having &gt;35 % absolute risk of a CVD event in the next 10 years is the most cost-effective intervention. This intervention costs US$67 per DALY averted and about US$7 million annually. Treatment of acute myocardial infarction (AMI) (costing US$1000–US$7530 per DALY averted) and secondary prevention of IHD and stroke (costing US$1060–US$10,340 per DALY averted) become more efficient when delivered in integrated packages. At an annual willingness-to-pay (WTP) level of about US$3 million, a package consisting of aspirin, streptokinase, ACE-inhibitor and beta-blocker for AMI has the highest probability of being most cost-effective, whereas as WTP increases to &gt; US$7 million, combination drug treatment to individuals having &gt;35 % absolute risk stands out as the most cost-effective strategy. Cost-effectiveness ratios were relatively more sensitive to halving the effectiveness estimates as compared with doubling the price of drugs and laboratory tests.<br>
Conclusions<br>
In Ethiopia, the escalating burden of CVD and its risk factors warrants timely action. We have demonstrated that selected CVD intervention packages could be scaled up at a modest budget increase. The level of willingness-to-pay has important implications for interventions’ probability of being cost-effective. The study provides valuable evidence for setting priorities in an essential healthcare package for CVD in Ethiopia.}},
  author       = {{Tolla, MT and Norheim, Ole F. and Memirie, ST and Abdisa, SG and Ababulgu, A and Jerene, Degu and Bertram, M and Strand, K and Verguet, S and Johansson, KA}},
  issn         = {{1478-7547}},
  language     = {{eng}},
  month        = {{08}},
  pages        = {{1--14}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Cost Effectiveness and Resource Allocation}},
  title        = {{Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis.}},
  url          = {{http://dx.doi.org/10.1186/s12962-016-0059-y}},
  doi          = {{10.1186/s12962-016-0059-y}},
  volume       = {{14}},
  year         = {{2016}},
}