Why the Need to Act Now (cont..)

Opportunities for Prevention and Control

The main finding from studying major declines in CVD mortality seen in several developed countries during the 1960s and 1970s was that nearly half the reduction can be attributed to population-level changes in risk factors, such as tobacco use, and the rest to treatment of disease and its complications— with most of the treatment effect due to early diagnosis and initiation of pharmacological interventions, rather than medical or surgical interventions. Clearly, both prevention and treatment are needed—the challenge is determining the appropriate mix.

Many interventions have been proposed for preventing or reducing the NCD burden.

The interventions are

Cost-effective interventions that address CVD, tobacco use, alcohol abuse, consumption of unhealthy fats, and excessive salt intake are now comparatively well understood.

For this current book, interventions were categorized using a two policy orientation:

1) Population-based interventions in the community,

2) Individual-based interventions within the clinical setting.

Population-based interventions in the community

In terms of population-based interventions, the effects of key tobacco measures and a reduction in salt intake of 15 percent modeled in 23 low- and middle-income countries found that over 10 years, 13.8 million deaths could be averted, at a cost of less than US$0.40 per person a year in low-income and lower middle-income countries, and US$0.50–1.00 per person a year in upper middle-income countries (as of 2005). For Bangladesh, India, and Pakistan (the three South Asian countries among the 23), the model predicts deaths averted in a range of 50–70 per 100,000 of the at-risk population (the population over age 30).

Individual-based interventions within the clinical setting

It's fairly strong effectiveness evidence from randomized control trials supporting the use a number of drugs to prevent CVD by reducing blood pressure or cholesterol now exists. This evidence has been used to model the cost-effectiveness of pharmacological interventions among high-risk individuals in the same set of 23 low- and middle-income countries. When scaling up the above current coverage levels, the model estimated that that over a 10 year period, a multidrug regimen for the prevention of CVD could avert 17.9 million deaths from CVD in these 23 countries. The 10-year average yearly cost per person would be US$1.08 (US$0.75–1.40), ranging from US$0.43 to US$0.90 across low-income countries and from US$0.54 to US$2.93 across middle-income countries.