Risk factor (top 5 from Table 1) | Intervention | Cost-effectiveness (incremental cost-effectiveness ratio [ICER])* | Further details and comments |
---|---|---|---|
High systolic blood pressure (BP) and high LDL cholesterol | Double therapy (an antihypertensive and a statin) by clinician-assessed absolute risk level | NZ$ 1580 per QALY gained in the > 20% in 5 years risk stratum (NZ$ 2011) (~ US$ 1160 in 2018) | Even in the lowest risk stratum (≤ 5% risk in 5 years), the cost per QALY was only NZ$ 25,500. These values were all just for middle-aged males [27] |
High LDL cholesterol | Lipid-lowering therapy (informed by clinician-assessed absolute risk level) | NZ$ 3740 per QALY gained in the > 20% in 5 years risk stratum (NZ$ 2011) (~ US$ 2750 in 2018) | This compared with the ICER in the lowest risk stratum (≤ 5% risk in 5 years), of $43,500 (95% uncertainty interval [UI]: $22,400 to $73,700) [27]. These values were all just for middle-aged males. Of note was that the ICER was more favorable when double therapy was studied (see elsewhere in this table) |
High systolic BP | Antihypertensive therapy (informed by clinician-assessed absolute risk level) | NZ$ 6470 per QALY gained in the > 20% in 5 years risk stratum (NZ$ 2011) (~ US$ 4760 in 2018) | This compared with the ICER in the lowest risk stratum (≤ 5% risk in 5 years), of NZ$ 62,400 (95%UI: 33,600 to 104,000) [27]. These values were all just for middle-aged males. Of note was that the ICER was more favorable when double therapy was studied (see elsewhere in this table) |
High systolic BP | Dietary counseling by dietitians to reduce sodium intake (as per current practice in NZ) | NZ$ 36,900 per QALY gained ($NZ 2011) (~ US$ 27,100 in 2018) | The 95%UI for this ICER was reasonably wide at: NZ$ 22,400 to 62,500 [23] |
High body-mass index (BMI) | Weight-loss dietary counseling by nurses in primary care | NZ$ 138,000 per QALY gained ($NZ 2011) (~ US$ 101,000 in 2018) | None of the ICERs for particular population groups (e.g., Māori at NZ$ 116,000) were much better [38]. Of note is that Table 2 refers to a program with an individual-level component, i.e., the mass media promotion of smartphone apps for weight loss [39]. See also the comment in Table 2 on physical activity interventions for weight loss |
Tobacco use | Exercise counseling to enhance smoking cessation | NZ$ 451,000 per QALY gained ($NZ 2012) (~ US$ 328,000 in 2018) | This ICER was based on the 24-week follow-up data, using a discount rate of 3.5% [37], and is probably the most realistic ICER calculated in this study. As such, this ICER would not be considered cost-effective in the NZ context. Of note are population programs which involve an individual-level component that are estimated to be cost-saving. These are listed in Table 2 and involve smoking cessation counseling (with Quitline promotion) [33] and a program for the promotion of smartphone apps for smoking cessation [34] |