Evidence for cost-effectiveness of lifestyle primary preventions for cardiovascular disease in the Asia-Pacific Region: a systematic review

Abstract

BackgroundCountries of the Asia Pacific region account for a major share of the global burden of disease due to cardiovascular disease (CVD) and this burden is rising over time. Modifiable behavioural risk factors for CVD are considered a key target for reduction in incidence but their effectiveness and cost-effectiveness tend to depend on country context. However, no systematic assessment of cost-effectiveness of interventions addressing behavioural risk factors in the region exists.MethodsA systematic review of the published literature on cost-effectiveness of interventions targeting modifiable behavioural risk factors for CVD was undertaken. Inclusion criteria were (a) countries in Asia and the Pacific, (b) studies that had conducted economic evaluations of interventions (c) published papers in major economic and public health databases and (d) a comprehensive list of search words to identify appropriate articles. All authors independently examined the final list of articles relating to methodology and findings.ResultsUnder our inclusion criteria a total of 28 studies, with baseline years ranging from 1990 to 2012, were included in the review, 19 conducted in high-income countries of the region. Reviewed studies assessed cost-effectiveness of interventions for tobacco control, alcohol reduction, salt intake control, physical activity and dietary interventions. The majority of cost-effectiveness analyses were simulation analyses mostly relying on developed country data, and only 6 studies used effectiveness data from RCTs in the region. Other than for Australia, no direct conclusions could be drawn about cost-effectiveness of interventions targeting behavioural risk factors due to the small number of studies, interventions that varied widely in design, and varied methods for measurement of costs associated with interventions.ConclusionsGood quality cost-effectiveness information on interventions targeting behavioural interventions for the Asia-Pacific region remains a major gap in the literature.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-014-0079-3) contains supplementary material, which is available to authorized users.

Prevalence of non-communicable disease risk factors among poor shantytown residents in Dhaka, Bangladesh: a community-based cross-sectional survey

“…Our qualitative study found that the community residents sprinkled table salt on rice because they liked the salty taste and served salt with meals for welcoming guests. 16 While salt reduction is known to be a cost effective strategy to prevent cardiovascular diseases, 38 39 it is difficult to modify the dietary habits of individuals in a short time period. Thus, a long-term community-wide campaign to modify the diets of community residents is necessary, as shown in successful model programmes in Japan.…”

Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies

“…However, without sustained compliance of subjects with advocated lifestyle changes, weight regain over the long-term can alter the quality of life and impinge on the estimated cost-effectiveness of interventions. Considering exclusively the short-term effects of obesity control interventions can indeed be misleading [ 49 ]. For this reason, it is not impossible that the cost-effectiveness of some interventions reviewed here and focusing on obesity was overestimated.…”

Economics of physical activity in low-income and middle- income countries: a systematic review

“…The search strategy was informed by a scoping review that covered relevant reviews on economics studies of PA, 17–23 reviews on PA 24–26 and reviews on economic evaluations. 27–29 The final search strategy including search terms for each database is given in online supplemental file 2 .…”