title: Economic appraisal of a community-wide cardiovascular health awareness program.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is a leading cause of hospitalizations, death, and health care costs. Although studies have shown that modifying CVD risk factors at the patient level improves patient prognosis, the effect of community-wide interventions at the population level has been uncertain.
  
  
  OBJECTIVE
  To evaluate the resource use and cost consequences of a community-wide Cardiovascular Health Awareness Program (CHAP).
  
  
  METHODS
  Thirty-nine medium-sized communities in Ontario, Canada, participated in a community cluster randomized controlled trial stratified by population size and geographic location. All community-dwelling elderly residents (>65 years) in each community were included. Family physicians, pharmacists, community nurses, local organizations, and volunteers in the intervention communities implemented the program. Rates and costs of CVD hospitalizations, all hospitalizations, emergency department visits, physician visits, and prescription medication use in the year before and after the intervention were compared for the 19 control and 20 CHAP communities by using province-wide linked administrative databases. The cost of implementing and administrating CHAP in each community was combined with total community health care cost to determine the net cost effect.
  
  
  RESULTS
  CHAP was associated with a reduction in CVD hospitalization costs. There were no differences in utilization rates or costs for overall hospitalizations, in visits to emergency rooms, physicians, or specialists, or in the use of prescription medications. Results were robust over a range of cost assumptions.
  
  
  CONCLUSIONS
  A community-wide CVD awareness program can be implemented and can reduce CVD-related hospitalization costs at the level of the community without a corresponding increase in overall health care costs.
authors: Programs for Assessment of Technology in Health Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. goereer@mcmaster.ca
authors: Ron
authors: R
authors: Goeree
authors: Camilla
authors: C
authors: von Keyserlingk
authors: Natasha
authors: N
authors: Burke
authors: Jing
authors: J
authors: He
authors: Janusz
authors: J
authors: Kaczorowski
authors: Larry
authors: L
authors: Chambers
authors: Lisa
authors: L
authors: Dolovich
authors: J
authors: J
authors: Michael Paterson
authors: Brandon
authors: B
authors: Zagorski
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D016000:Cluster Analysis; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D016208:Databases, Factual; D017048:Health Care Costs / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D009864:Ontario; D016730:Program Development; D015397:Program Evaluation; D012307:Risk Factors