title: Cost effective interventions for the prevention of cardiovascular disease in low and middle income countries: a systematic review.
abstract: BACKGROUND
  While there is good evidence to show that behavioural and lifestyle interventions can reduce cardiovascular disease risk factors in affluent settings, less evidence exists in lower income settings.This study systematically assesses the evidence on cost-effectiveness for preventive cardiovascular interventions in low and middle-income settings.
  
  
  METHODS
  
  
  
  METHODS
  Systematic review of economic evaluations on interventions for prevention of cardiovascular disease.
  
  
  METHODS
  PubMed, Web of Knowledge, Scopus and Embase, Opensigle, the Cochrane database, Business Source Complete, the NHS Economic Evaluations Database, reference lists and email contact with experts.
  
  
  METHODS
  we included economic evaluations conducted in adults, reporting the effect of interventions to prevent cardiovascular disease in low and middle income countries as defined by the World Bank. The primary outcome was a change in cardiovascular disease occurrence including coronary heart disease, heart failure and stroke.
  
  
  METHODS
  After selection of the studies, data were extracted by two independent investigators using a previously constructed tool and quality was evaluated using Drummond's quality assessment score.
  
  
  RESULTS
  From 9731 search results we found 16 studies, which presented economic outcomes for interventions to prevent cardiovascular disease in low and middle income settings, with most of these reporting positive cost effectiveness results.When the same interventions were evaluated across settings, within and between papers, the likelihood of an intervention being judged cost effective was generally lower in regions with lowest gross national income. While population based interventions were in most cases more cost effective, cost effectiveness estimates for individual pharmacological interventions were overall based upon a stronger evidence base.
  
  
  CONCLUSIONS
  While more studies of cardiovascular preventive interventions are needed in low and mid income settings, the available high-level of evidence supports a wide range of interventions for the prevention of cardiovascular disease as being cost effective across all world regions.
authors.affiliation: Department of Public Health & Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, UK. amir.shroufi@doctors.org.uk
authors.forename: Amir
authors.initials: A
authors.lastname: Shroufi
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chowdhury
authors.forename: Raghupathy
authors.initials: R
authors.lastname: Anchala
authors.forename: Sarah
authors.initials: S
authors.lastname: Stevens
authors.forename: Patricia
authors.initials: P
authors.lastname: Blanco
authors.forename: Tha
authors.initials: T
authors.lastname: Han
authors.forename: Louis
authors.initials: L
authors.lastname: Niessen
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D015397:Program Evaluation
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