title: Which interventions offer best value for money in primary prevention of cardiovascular disease?
abstract: BACKGROUND
  Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease.
  
  
  RESULTS
  In a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit.
  
  
  CONCLUSIONS
  There is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.
authors: School of Population Health, The University of Queensland, Herston, Queensland, Australia. l.cobiac@uq.edu.au
authors: Linda J
authors: LJ
authors: Cobiac
authors: Anne
authors: A
authors: Magnus
authors: Stephen
authors: S
authors: Lim
authors: Jan J
authors: JJ
authors: Barendregt
authors: Rob
authors: R
authors: Carter
authors: Theo
authors: T
authors: Vos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D003362:Cost-Benefit Analysis; D005260:Female; D019981:Health Care Sector / Q000191:economics; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics*
chemical_list: D002784:Cholesterol