Cost-effectiveness of a statewide public health intervention to reduce cardiovascular disease risk

Abstract

Background The cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) risk-reduction interventions is not well established. Colorado Heart Healthy Solutions is a CHW-based intervention designed to reduce modifiable CVD risk factors. This program has previously demonstrated success, but the cost-effectiveness is unknown. CHW-based interventions are potentially attractive complements to healthcare delivery because laypersons implement the intervention at a lower cost relative to medical care and may be attractive in rural settings with limited clinical resources. Methods CHWs performed screenings and provided ongoing participant support within predominantly rural communities. A point-of-service software tool was used to generate 10-year Framingham CVD risk scores and assist CHWs to make medical referrals and provide ongoing individualized support for lifestyle changes. A sample of program participants returned for reassessment of risk factors. We calculated quality-adjusted life years (QALYs) gained and program costs using a Markov model. Transition probabilities were calculated using Framingham risk equations or derived from the literature using the observed mean reduction in 10-year CVD risk score over of 37- months follow-up. Program cost-effectiveness was calculated for both at-risk (abnormal baseline CVD risk factors) and overall program populations. Results The base-case scenario evaluating a 52-year-old male participant revealed an incremental cost savings of $3576 and a gain of 0.16 QALYs associated with the intervention. Cost savings were greater in at-risk populations. The economic dominance of the model was robust in multiple sensitivity analyses. Conclusions A community-based CVD intervention demonstrated to reduce CVD risk is cost-effective. This suggests that population-based public health programs may have the potential to complement primary care preventative services to improve health and reduce the burden of traditional medical care.

Effectiveness of Complaint Services at the Talise Health Center Regional Technical Implementation Unit

“…So the research requires a number of data that are actual and contextual in nature. In addition, the qualitative approach has a high adaptability to changes that occur, and allows the author to constantly adapt to the changing conditions and situations encountered in this research [9]. The research location chosen by the author is in the Service Technical Implementation Unit of the Talise Health Center with the consideration that the Talise Health Center is the health center that provides the most direct services to the community and is one of the Complaints Unit Pilot Projects in Palu City.…”

The Effectiveness of the Environmental Health Services in the Primary Health Care Against the Prevention of Pulmonary Tuberculosis in the Regency of Banyuwangi

“…In this study, the evaluation of the effectiveness of the environmental health services in the primary health care on the patients with pulmonary TB using model approach of system resources, namely the rate of the variable input, process and output by considering the needs of the patient against the health services program for the environment (11). Input variables included policy, human resources, infrastructure and budget.…”

Screening for Cardiovascular Disease in Pregnancy: Is There a Need?

“…One study evaluating the cost-effectiveness of cardiovascular screening performed by Smith et al out of Colorado demonstrated a screening tool in combination with community health workers reaching out to individuals to implement interventions resulted in a 0.8% reduction in Framingham risk score in the general population and a 2.0% reduction in an at-risk population. In their cost analyses, they demonstrated not just an increase in quality-adjusted life-years (QALYs) but, more importantly, a significant savings in healthcare costs in both the general population as well as an at-risk population [ 19 ]. Given the large proportion of pregnancy-related mortality attributed to cardiovascular disease, these data suggest that an implementation of universal screening may be beneficial to overall healthcare costs in addition to improvement of overall maternal outcomes; however, a secondary analysis of healthcare-related costs would be indicated after implementation of our algorithm.…”