Modelling the impact on avoidable cardiovascular disease burden and costs of interventions to lower SBP in the England population.

BACKGROUND: The burden of disease from cardiovascular disease (CVD) remains significant in England. Blood pressure remains an important risk factor. Health gain through public health measures and improving treatment compliance are potentially likely to be high. We assess the impact of known cost-effective interventions in terms of the avoidable CVD burden and costs by comparing these strategies to the current situation.
METHODS: We modelled avoidable CVD outcomes simulating the English population aged over 16 years with Excel spreadsheets for the current prevention/treatment and following various interventions over a 10-year time frame. The outcome measures were avoidable incident heart disease and stroke events, deaths and disability-adjusted life years (DALYs). Costs are reported from the health service perspective. We analysed relative cost-effectiveness, undertook sensitivity analysis and measured relative impacts of different strategies on avoidable burden of disease.
RESULTS: The assessed interventions have a potential to reduce the current burden of disease between 70 000 and about 1 million DALYs over the 10-year frame. Although all interventions were cost-effective, some (e.g. Salt reduction in the population and 'Dietary Approaches to Stop Hypertension-sodium', which modelled the impact of salt reduction and dietary approaches) were cost-saving. The cost-effectiveness of treatment strategies was sensitive to drug costs.
CONCLUSION: Evidence-based interventions appropriately scaled up for both prevention and treatment of blood pressure lead to important additional potential health gains. There was noticeable variance in cost-effectiveness and impact among the different interventions at a population level. Taking into account impact, priority should be given to prevention to reduce blood pressure at a population level through reduced salt consumption.