title: WHO/ISH total risk approach for primary prevention of cardiovascular disease shows greater decrease in costs for women but not the elderly in Jamaica.
abstract: OBJECTIVE
  To investigate cost savings from and implications of replacing the single risk with a total cardiovascular risk approach in primary prevention of cardiovascular disease (CVD).
  
  
  METHODS
  A cost analysis using data from the 2007-08 Jamaica Health and Lifestyle Survey of 1,432 persons aged 40 years and older with 10-year risk estimated from region-specific World Health Organization/International Society for Hypertension (WHO/ISH) CVD risk charts. The WHO/ISH and local treatment guidelines were used to cost lifestyle changes, medications, and provider visits.
  
  
  RESULTS
  Use of the total cardiovascular risk approach was less costly regardless of age. Women showed greater cost disparity. However, if 10-year CVD risk was estimated without measured cholesterol, both approaches resulted in similar costs in men ≥60 years. The annual per capita cost of lifestyle recommendations, critical in the absence of pharmacotherapy, was estimated at US $869.05 for diet and US $80 for physical activity. This represents about a third of the annual income of a minimum wage earner. At the national level, implementation of the WHO/ISH total risk approach could reduce health care costs by US $5 million annually.
  
  
  CONCLUSIONS
  Cost savings that mainly resulted from reduced care for women may lead to gender disparity in CVD outcomes.
authors.affiliation: Department of Economics, The University of the West Indies, Mona Campus, Kingston 7, Jamaica. Electronic address: abdullahi.abdulkadri@uwimona.edu.jm.
authors.forename: Abdullahi O
authors.initials: AO
authors.lastname: Abdulkadri
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Marshall K
authors.initials: MK
authors.lastname: Tulloch-Reid
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Damian K
authors.initials: DK
authors.lastname: Francis
authors.affiliation: Mona Office for Research and Innovation, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Georgiana M
authors.initials: GM
authors.lastname: Gordon-Strachan
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Novie O
authors.initials: NO
authors.lastname: Younger-Coleman
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Kern D
authors.initials: KD
authors.lastname: Rocke
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Shelly R
authors.initials: SR
authors.lastname: McFarlane
authors.affiliation: Department of Community Health and Psychiatry, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Colette A
authors.initials: CA
authors.lastname: Cunningham-Myrie
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Trevor S
authors.initials: TS
authors.lastname: Ferguson
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
authors.forename: Rainford J
authors.initials: RJ
authors.lastname: Wilks
authors.affiliation: Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona Campus, Kingston 7, Jamaica; Institute of Cardiovascular Sciences, The University of Manchester, Core Technology Facility (3rd floor), 46 Grafton Street, Manchester, M13 9NT, UK.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D017046:Cost Savings; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007390:International Agencies; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics*; D012307:Risk Factors; D012737:Sex Factors; D014944:World Health Organization
keywords: Cardiovascular disease; Cost analysis; Health care disparity; Jamaica; Prevention and control; Risk assessment