Optimizing cardiovascular disease risk screening in a low-resource setting: cost-effectiveness of program modifications in Sri Lanka modelled with nationally representative survey data

Nilmini Wijemunige*, Ravindra P. Rannan-Eliya, Pieter van Baal, Owen O’Donnell

*Corresponding author for this work

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Abstract

Background: While screening for cardiovascular disease (CVD) risk can help low-resource health systems deliver low-cost, effective prevention, evidence is needed to adapt international screening guidelines for maximal impact in local settings. We aimed to establish how the cost-effectiveness of CVD risk screening in Sri Lanka varies with who is screened, how risk is assessed, and what thresholds are used for prescription of medicines. Methods: We used data for people aged 35 years and over from a 2018/19 nationally representative survey in Sri Lanka. We modelled the costs and quality adjusted life years (QALYs) for 128 screening program scenarios distinguished by a) age group screened, b) risk tool used, c) definition of high CVD risk, d) blood pressure threshold for treatment of high-risks, and e) prescription of statins to all diabetics. We used the current program as the base case. We used a Markov model of a one-year screening program with a lifetime horizon and a public health system perspective. Results: Scenarios that included the WHO-2019 office-based risk tool dominated most others. Switching to this tool and raising the age threshold for screening from 35 to 40 years gave an incremental cost-effectiveness ratio (ICER) of $113/QALY. Lowering the CVD high-risk threshold from 20 to 10% and prescribing antihypertensives at a lower threshold to diabetics and people at high risk of CVD gave an ICER of $1,159/QALY. The findings were sensitive to allowing for disutility of daily medication. Conclusions: In Sri Lanka, CVD risk screening scenarios that used the WHO-2019 office-based risk tool, screened people above the age of 40, and lowered risk and blood pressure thresholds would likely be cost-effective, generating an additional QALY at less than half a GDP per capita.

Original languageEnglish
Article number1792
JournalBMC Public Health
Volume23
Issue number1
DOIs
Publication statusE-pub ahead of print - 15 Sept 2023

Bibliographical note

Funding Information:
The data collection underlying this research, and analysis, was supported by the Swiss Agency for Development Cooperation (SDC) and the Swiss National Science Foundation (SNSF) through the Swiss Programme for Research on Global Issues for Development (r4d programme) by the grant “Inclusive social protection for chronic health problems” (Grant number 400640_160374), and the Institute for Health Policy Public Interest Research Fund (Grant number PIRF-2018–02).

Publisher Copyright: © 2023, BioMed Central Ltd., part of Springer Nature.

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