WHO/ISH total risk approach for primary prevention of cardiovascular disease shows greater decrease in costs for women but not the elderly in Jamaica

• Published in: Journal of clinical epidemiology Vol. 68; no. 9; pp. 994 - 1001
• Main Authors: Abdulkadri, Abdullahi O, Tulloch-Reid, Marshall K, Francis, Damian K, Gordon-Strachan, Georgiana M, Younger-Coleman, Novie O, Rocke, Kern D, McFarlane, Shelly R, Cunningham-Myrie, Colette A, Ferguson, Trevor S, Wilks, Rainford J, Anderson, Simon G
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2015; Elsevier Limited
• Subjects: Adult; Age; Age Factors; Aged; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - economics; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Chronic illnesses; Cost analysis; Cost control; Cost Savings; Developing Countries; Diabetes; Drug therapy; Epidemiology; Female; Health care access; Health Care Costs; Health care disparity; Health care expenditures; Health care policy; Health risk assessment; Health risks; Humans; Hypertension; Internal Medicine; International Agencies; Jamaica; Jamaica - epidemiology; Lifestyles; Male; Mens health; Middle Aged; Mortality; Obesity; Older people; Population; Prevention; Prevention and control; Primary Prevention - economics; Risk assessment; Risk Factors; Sex Factors; Subsidies; Womens health; World Health Organization; Jamaica; United States > US; ASW, Caribbean Sea, Greater Antilles, Jamaica; Cardiovascular disease; Prevention and control; Cost analysis; Jamaica; Risk assessment; Health care disparity
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2014.11.027

Abstract Objectives To investigate cost savings from and implications of replacing the single risk with a total cardiovascular risk approach in primary prevention of cardiovascular disease (CVD). Study Design and Setting A cost analysis using data from the 2007–08 Jamaica Health and Lifestyle Survey of 1,432 persons aged 40 years and older with 10-year risk estimated from region-specific World Health Organization/International Society for Hypertension (WHO/ISH) CVD risk charts. The WHO/ISH and local treatment guidelines were used to cost lifestyle changes, medications, and provider visits. Results Use of the total cardiovascular risk approach was less costly regardless of age. Women showed greater cost disparity. However, if 10-year CVD risk was estimated without measured cholesterol, both approaches resulted in similar costs in men ≥60 years. The annual per capita cost of lifestyle recommendations, critical in the absence of pharmacotherapy, was estimated at US $869.05 for diet and US $80 for physical activity. This represents about a third of the annual income of a minimum wage earner. At the national level, implementation of the WHO/ISH total risk approach could reduce health care costs by US $5 million annually. Conclusion Cost savings that mainly resulted from reduced care for women may lead to gender disparity in CVD outcomes.