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Cost Effectiveness

Cost effectiveness

  • Cardiovascular disease (CVD) is largely preventable. Yet direct and indirect costs of CVD disease approached $450 billion per year in 2010 and are projected to surpass $1 trillion annually by 2030.1
  • Only 18% of adults follow the three major measures that increase heart health: not smoking, maintaining a healthy body weight, and exercising five times a week. Around 33% of adults do not engage in any vigorous physical activity. One in three adults has high blood pressure, and 36% of them do not have it controlled, while 44% of adults have high cholesterol. At least 65% of type 2 diabetes patients die from heart disease or stroke, and more than 25 million Americans have diagnosed and undiagnosed diabetes, with 37% of the population having pre-diabetes. Nearly one in six children and adolescents are obese. 1
  • Cost-effectiveness analyses by American Heart Association suggest that public policy, community efforts, and pharmacological intervention are not only effective but also cost-effective and often cost saving compared with common benchmarks. The new cost-effectiveness analyses shows that exercise and diet programs, tobacco control strategies, obesity management plans, diabetes screens, and other initiatives add value or save money over time. Strong evidence supports pharmacological treatment of risk factors to prevent cardiovascular events, and evidence is growing that public policy and lifestyle intervention work as well (Table 130A.)

 

Table 130A.Cost effectiveness of selected interventions1

  • Community-based programs to increase exercise, improve nutrition, and prevent smoking and tobacco use carry a return-on-investment (ROI) of $5.60 for every dollar spent over five years
  • Worksite wellness programs can decrease medical costs by $3.27 for every dollar spent on them within the first 12 to 18 months
  • School-based initiatives to promote healthy eating cost just $900 to $4,305 per quality-adjusted life year (QALY) saved
  • Building trails for walking and biking save $3 in medical costs for every dollar spent on construction
  • Exercise interventions like pedometer and walking programs have an incremental cost-effectiveness ratio ranging from $14,000 to $69,000 per QALY gained
  • Reducing sodium intake to 1,500 mg/day results in $26.2 billion in healthcare savings annually
  • Year-long obesity management programs have an ROI of $1.17 for every dollar spent
  • A 40% tax-induced cigarette price increase could save $682 billion in medical costs by 2025
  • Smoke-free air laws save $10 billion in healthcare costs annually
  • Screening for diabetes based on age and risk have a cost-effectiveness of $46,800 to $70,500 per QALY gained
  • Statin use could prevent 20,000 heart attacks and 10,000 cardiovascular deaths at a cost of $42,000 per QALY if pills cost $2.11 per pill (though generic statins are significantly cheaper
  • Hypertension medications cost about $37,100 per life-year saved.
  • Now that the price of generic statins have come down to $4 per month giving statins to those >35 years and older would save $9900 per QALY gained if given to those at moderately high risk (2 or more risk factors and LDL-C >130 mg/dl).2
  • Research shows that 90% of health interventions cost money to implement, but only about 10% are genuinely cost-saving, and those include staples such as child vaccinations, prenatal care, and statins.
  • While many heart disease prevention programs cost about $10,000 to $50,000 to implement, treatment costs are usually far higher.1
  • Dialysis for end-stage renal disease (ESRD), for instance, can cost as much as $100,000 per QALY, while left-ventricular assist devices cost $500,000 to $1.4 million per QALY.1

Sources

1. Weintraub W S, Daniels SR, Burke LE, et al. Value of Primordial and Primary Prevention for Cardiovascular Disease: A Policy Statement From the American Heart Association. Circulation. Jul 25 2011.

2. Lazar L D, Pletcher MJ, Coxson PG, Bibbins-Domingo K, Goldman L. Cost-effectiveness of statin therapy for primary prevention in a low-cost statin era. Circulation. Jul 12 2011;124(2):146-153.

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