Cost-Effectiveness Analysis of Interventions to Prevent Cardiovascular Disease in Vietnam

This study sought to assess the costs, health effects, and cost-effectiveness of a set of personal and non-personal prevention strategies to reduce cardiovascular disease in Vietnam, which accounts for one-third of total deaths in the country. These strategies included mass media campaigns (radio, TV, print media, and print materials) for reducing consumption of salt and tobacco, drugs for lowering blood pressure or cholesterol, and combined pharmacotherapy for people at varying levels of absolute risk of a cardiovascular event.

The authors report the use of WHO-CHOICE (World Health Organization - Choosing Interventions That Are Cost-Effective) methods and analytical models, combined with local data to estimate the costs, effects, and cost-effectiveness of 12 population (based on the concept that the majority of cases occur amongst people with medium and low levels of risk) and individual interventions (based on published studies about the impact of many interventions) implemented singly or in combination. Costs of the interventions were measured in Vietnamese currency (Dong) for the year 2007. Health effects were calculated in age-weighted and discounted disability-adjusted life years (DALYs) averted.

Results showed that the least costly interventions are health education programs through mass media, with a total cost per year of 89 billion Dong or US$0.06 per capita). By contrast, combination drug treatment for individuals with a 5% absolute risk of a cardiovascular event is the most costly intervention - 4121 billion Dong /year, equivalent to US$2.90 per capita. In terms of effectiveness, individual interventions save more DALYs than population-wide interventions, but are more costly. The authors also reported that a health education program to reduce salt intake (at a cost of US$118 per DALY averted) and individual treatment of systolic blood pressure above 160mmHg (at a cost of US$78 per DALY averted) were the most cost-effective measures for population- and individual-based approaches, respectively.

The authors conclude that in cases where budget is very limited, a mass media education program on salt intake combined with a mass media program that addresses salt intake, cholesterol and tobacco should be selected first. If more resources are available, then greatest population health gains can be achieved via individual treatment of systolic blood pressure and the absolute risk approach to cardiovascular disease prevention. However, the authors also caution that geographic and social equity might play a role in these types of analysis. Further, they argue that the results of the study provide strong evidence for more informed policy making in this area.