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Abstract

Treatment of individuals in low-income and middle-income countries at high risk for cardiovascular disease with a preventive multidrug regimen could prevent almost a fifth of all deaths from cardiovascular disease, research shows. The study, Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs, suggests that scaling up of this multidrug regimen could avert nearly 18 million deaths from cardiovascular disease over the next 10 years in the low-income and middle-income countries studied. The work was done in collaboration with scientists at the University of Queensland, Harvard Medical School, the Public Health Foundation of India, the All India Institute of Medical Services, the Harvard School of Public Health, the Mexican Ministry of Health, and the University of Auckland.

Research findings

The researchers found that over a 10-year period, scaling up a multidrug regimen (including aspirin, blood pressure-lowering drugs, and a cholesterol-lowering drug) was estimated to avert 17.9 million deaths from cardiovascular disease, with the majority of deaths prevented in adults younger than 70 years. This reduction amounts to almost a fifth of cardiovascular disease deaths that would have otherwise occurred in these countries during this time period, and could effectively meet three-quarters of the proposed global goal to reduce chronic disease death rates by an additional 2% per year over the next 10 years. The 10-year financial cost in the 23 low-income and middle-income countries studied would be $47 billion, or an average yearly cost of $1.08 per person. This cost includes resources spent on medicines, screening, treatment, laboratory testing, program administration, training, monitoring, and assessment of the program.

Analytical approach

The 23 countries included in the analysis account for 80% of the global chronic disease deaths in all low-income and middle-income countries. A public provider perspective for costs was used, with costs reported in 2005 US$ over the period 2006 to 2015. A simulation model was used to create a series of 10,000 individual life histories for each five-year age- and sex-group over the period 2006 to 2015 for each country. The simulation was done using information on the population distribution of risk factors, correlations between risk factor levels, associations between risk factors and disease, and population-level estimates of ischemic heart disease, cerebrovascular events, and other mortality. Age-specific and sex-specific trends in risk factor rates and mortality were also included.

Research objective

The researchers aimed to estimate the number of deaths between 2006 and 2015 that could be averted and the financial cost of scaling up a multidrug regimen for prevention of cardiovascular disease in a selection of low- and middle-income countries. This research is part of ongoing work by IHME to provide decision-makers with timely, comparable, and forward-looking information to inform choices about policies and funding – especially in countries with scarce resources.

Recommendations for future work

Chronic disease deaths are projected to continue to rise in low-income and middle-income countries. Urgent attention should be paid to increasing efforts to prevent this rising burden. The researchers suggest that some countries will need large amounts of funding from external donors to cover the costs of intervention for individuals at risk of cardiovascular disease. With two-thirds of the per-person cost due to drug costs, a range of policies is required at international and country levels to promote local manufacturing of generic products, pooled procurements, and regulated pricing to ensure availability of inexpensive, high-quality cardiovascular medicines. Additionally, combining effective medicines into one pill would reduce the complexity of a multidrug regimen and potentially improve adherence. Finally, primary health care systems will need to be strengthened, particularly in the poorest settings, before scale-up can proceed.
Citation: 

Lim SS, Gaziano TA, Gakidou E, Reddy KS, Farzadfar F, Lozano R, Rodgers A. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs. The Lancet. 2007 Dec 15; 370:2054–2062.