Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk

Murray, Christopher J L; Lauer, Jeremy A.; Hutubessy, Raymond; Niessen, Louis; Tomijima, Niels; Rodgers, Anthony; Lawes, Carlene M.M.; Evans, David B.

doi:10.1016/s0140-6736(03)12655-4

Cited by 497 publications

(367 citation statements)

References 29 publications

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“…Although they are applied in different forms, all of them have the objective of reducing cardiovascular risk factors, including SAH. 10,11,13,18 In Brazil, studies on the theme also concentrate on the analysis of effectiveness. In one of them, 98% of adherence and impact of PSF of 57% regarding blood pressure control were observed, with a mean of 10.1, ± 3.9 consultations per year in the state of Bahia, Northeastern Brazil.…”

Section: Discussionmentioning

confidence: 99%

Avaliação das ações em hipertensão arterial sistêmica na atenção básica

Rabetti¹,

Freitas²

2011

Rev. Saúde Pública

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OBJECTIVE:To evaluate the effi ciency of the Family Health Strategy in actions related to hypertension. METHODS:Evaluative, cross-sectional quantitative research based on secondary data of 66 small municipalities located in the state of Santa Catarina, Southern Brazil, with maximum potential coverage of 100% by the Family Health Strategy in 2007. Input indicators, products and results were evaluated. The municipalities' effi ciency of services production and results production was compared through data envelopment analysis. RESULTS:The municipalities were more effi cient in services production (37.8%) than in results production (16.6%). Forty-one municipalities (62.2%) were ineffi cient in the services: enrolment in the Hypertension and Diabetes Information System, individual assistance and home visit for hypertensive users, and 55 (83.3%) were ineffi cient in the production of impact against hypertension. CONCLUSIONS:The evaluation model used in this study proved to be capable of measuring effi ciency in primary healthcare by evaluating the productivity of services and results.

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Section: Discussionmentioning

confidence: 99%

Avaliação das ações em hipertensão arterial sistêmica na atenção básica

Rabetti¹,

Freitas²

2011

Rev. Saúde Pública

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“…Some federal health systems compare their own gross domestic product (GDP) per capita to the cost per QALY of new medical interventions when deciding to approve new drugs based on the World Health Organization’s (WHO) one-to-three times GDP per capita recommendation [13,14]. However, this recommended threshold is based on a long-standing misinterpretation and not on any methodological justification [3,15–20].…”

Section: Introductionmentioning

confidence: 99%

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review

Cameron

Ubels

Norström

2018

Global Health Action

212

172

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Background: The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system. Objectives: The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data. Methods: A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations. Results: Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made. Conclusions: Most national C/E thresholds identified in our review fall within the WHO’s recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they base their decision-making process on erroneous presumptions or non-evidence-based methodologies. The commonly referred to value of 100,000$ USD per QALY may potentially have some basis.

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“…1 A more recent paper in the Lancet demonstrates that nonpersonal health interventions, such as legislation to lower the salt content of processed foods or mass-media messages to change diet, to lower systolic blood pressure and cholesterol are cost-effective ways to limit cardiovascular disease and could avert over 21 million DALYs (disability-adjusted life years) per year worldwide. 2 A recently published meta-analysis of one million adults in 61 prospective studies demonstrates that the relation between blood pressure and cardiovascular risk is considerably stronger than previously estimated and for the first time clearly quantifies the risk for systolic blood pressure. 3 In England the 1998 Health Survey found that in adults (16 years or older) 42% of men and 33% of women have high blood pressure, defined as systolic blood pressure X140 mmHg or diastolic (DBP) X90 mmHg or on blood pressure treatment.…”

Section: Introductionmentioning

confidence: 99%

Cost of poor blood pressure control in the UK: 62 000 unnecessary deaths per year

MacGregor

2003

J Hum Hypertens

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Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk

Cited by 497 publications

References 29 publications

Avaliação das ações em hipertensão arterial sistêmica na atenção básica

Avaliação das ações em hipertensão arterial sistêmica na atenção básica

On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review

Cost of poor blood pressure control in the UK: 62 000 unnecessary deaths per year

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