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Table 3 Cost-effectiveness of individual-level interventions for preventing CVD from studied interventions in the NZ context (in descending order of cost-effectiveness)

From: Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

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]

  1. *All calculated from a NZ health system perspective, for the lifetime of the studied population, and at a 3% discount rate (unless otherwise stated).