title: Health and Economic Implications of National Treatment Coverage for Cardiovascular Disease in India: Cost-Effectiveness Analysis.
abstract: BACKGROUND
  Whether to cover cardiovascular disease costs is an increasingly pressing question for low- and middle-income countries. We sought to identify the impact of expanding national insurance to cover primary prevention, secondary prevention, and tertiary treatment for cardiovascular disease in India.
  
  
  RESULTS
  We incorporated data from coverage experiments into a validated microsimulation model of myocardial infarction and stroke in India to evaluate the cost-effectiveness of alternate coverage strategies. Coverage of primary prevention alone saved 3.6 million disability-adjusted life-years (DALY) per annum at an incremental cost-effectiveness ratio of $469 per DALY averted when compared with the status quo of no coverage. Coverage of primary and secondary preventions was dominated by a strategy of covering primary prevention and tertiary treatment, which prevented 6.6 million DALYs at an incremental cost-effectiveness ratio of $2241 per DALY averted, when compared with that of primary prevention alone. The combination of all 3 categories yielded the greatest impact at an incremental cost per DALY averted of $5588 when compared with coverage of primary prevention plus tertiary treatment. When compared with the status quo of no coverage, coverage of all 3 categories of prevention/treatment yielded an incremental cost-effectiveness ratio of $1331 per DALY averted. In sensitivity analyses, coverage of primary preventive treatments remained cost-effective even if adherence and access to therapy were low, but tertiary coverage would require avoiding unnecessary procedures to remain cost-effective.
  
  
  CONCLUSIONS
  Coverage of all 3 major types of cardiovascular treatment would be expected to have high impact and reasonable cost-effectiveness in India across a broad spectrum of access and adherence levels.
authors.affiliation: From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.). basus@stanford.edu.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basu
authors.affiliation: From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.).
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
authors.affiliation: From the Department of Medicine Prevention Research Center, Center for Primary Care and Outcomes Research, (S.B., E.B.), Department of Medicine Stanford Institute for Economic Policy Research, Prevention Research Center (S.B.), and Division of General Medical Disciplines (E.B.), Stanford University, Stanford, CA; Department of Economics National Bureau of Economic Research, Center for International Development, Stanford Institute for Economic Policy Research, Stanford, CA (S.B.); Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.B.); Department of Pharmaceutical Economics and Policy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (N.S.); and National Bureau of Economic Research, Cambridge, MA (N.S.).
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sood
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007194:India / Q000453:epidemiology; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000191:economics*; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D010349:Patient Compliance; D011314:Preventive Health Services / Q000191:economics*; D011322:Primary Prevention / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D055502:Secondary Prevention / Q000191:economics; D055512:Tertiary Prevention / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
keywords: cost-effectiveness; developing countries; health policy; healthcare economics and organizations; insurance; myocardial infarction; stroke