Targeting individuals at high risk of cardiovascular disease with a multi-drug regimen would avert millions of deaths with a moderate increase in expenditure. Further, this strategy could effectively meet three quarters of the global goal of reducing chronic disease death rates by an additional 2% per year. These are the conclusions of Dr Stephen Lim, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA, and colleagues, authors of this fourth paper in The Lancet Chronic Diseases Series.
Analysing the same 23 countries as in previous papers, the authors estimated that 17.9 million deaths could be averted by using a multidrug regimen of a statin, aspirin and two blood-pressure lowering medicines. This represents around one fifth of the deaths related to chronic disease in these countries. The costs of the strategy would range from US$0.43 to $0.90 across low-income countries and from $0.54 to $2.93 across middle-income countries, or an average yearly cost of $1.08 across the 23 countries a whole, with the total 10-year financial cost estimated at $47 billion. Around 56% of the deaths averted would be in those younger than 70 years, with more deaths averted in women than in men due to larger absolute numbers of women at older ages.
High risk individuals are defined as those aged between 40 and 79 years who have had non-fatal coronary heart disease or a cerebrovascular event. Individuals without existing disease but with an estimated absolute risk of dying from coronary heart disease or a cerebrovascular event of higher than 15% or more in the next ten years were also deemed high risk.
While the costs of this scale-up are similar to other health strategies, low-income countries will need large donations from external donors since the costs of the programme could be over 10% of their current health expenditure. It is in these settings that strengthening of the primary health care system will also be required. Another key factor will be the cost and availability of these medicines which in the public sector is low and, although availability is higher in the private sector, the price is substantially higher and unaffordable for most individuals who need them. The authors say: "If the financial burden is predominantly borne by the patient, this will also have a negative effect on coverage and patients' adherence, particularly in low-income settings. Long-term adherence, even in high-income settings, to cardiovascular prevention medication is typically low…further research on mechanisms to improve patients' adherence in developing countries could have a large effect on the success of the strategy proposed here."
The authors conclude by saying that their strategy does not discount the potential role of other individual approaches, such as encouraging dietary, lifestyle or behavioural changes. They say: "The approach described here should also not be regarded as an alternative, but rather is complementary to population-wide approaches. For example, when the individual approach described here and the population-wide approaches described in the third paper in this Series are combined, this could essentially meet the proposed global goal."
This paper associated with this release can be found at http://www.eurekalert.org/jrnls/lance/CD4.pdf
Journal
The Lancet