Cost-effectiveness Evidence on Prevention, Control, and Treatment of NCD(cont...)

Individual-based Interventions

There is fairly strong effectiveness evidence from randomized control trials supporting the use a number of drugs to prevent (or manage) CVD by reducing blood pressure or blood cholesterol (Jackson et al. 2005). This evidence has been used by Lim et al. (2007) to model the cost-effectiveness of pharmacological interventions among high-risk individuals in the same set of 23 low- and middle-income countries as Asaria et al. (2007).

In particular, Lim et al. model the financial costs and the mortality effects from scaling up, above current coverage levels, a multidrug regimen for the prevention of CVD (a statin, aspirin, and two bloodpressure- lowering medicines). Over a 10-year period, their average estimate suggests that this multidrug regimen could avert 17.9 million deaths from CVD in these 23 countries.

Approximately 56 percent of deaths averted would be in those younger than 70 years, with more deaths averted in women than in men owing to larger absolute numbers of women at older ages. The 10-year average yearly cost per head would be US$1.08 ($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.

For Bangladesh the annual financial costs of the package correspond to close to 5 percent of the annual health budget, while in India costs would account for more than 4 percent and in Pakistan about 3 percent. While promising, it is an open question whether and how the interventions can be implemented in a real-life developing-country context.

Concerns do remain in that health services for chronic NCDs tend to be fragmented and too weakly organized to be able to confront the challenge of preventing or managing chronic NCDs (Miranda et al. 2008). A key point is that risk factors tend to cluster (obesity, hypertension, and diabetes, for example, can occur in a single individual) and strategies should target multiple common ones.

A recently published trial—the Indian Polycap Study—has, however, demonstrated a significantly reduced CVD risk in a sample from India, suggesting that different versions of a polypill could be conveniently used to reduce multiple risk factors and cardiovascular risk (Yusuf et al. 2009). Other trials in developing-country contexts are also under way.