title: Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis.
abstract: BACKGROUND
  The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia's meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper's objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting.
  
  
  METHODS
  Fifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization's Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and price of traded and non-traded goods. Costs and health benefits were discounted at 3 % per year. Incremental cost-effectiveness ratios are reported in US$ per disability adjusted life year (DALY) averted. Sensitivity analysis was undertaken to assess robustness of our results.
  
  
  RESULTS
  Combination drug treatment for individuals having >35 % absolute risk of a CVD event in the next 10 years is the most cost-effective intervention. This intervention costs US$67 per DALY averted and about US$7 million annually. Treatment of acute myocardial infarction (AMI) (costing US$1000-US$7530 per DALY averted) and secondary prevention of IHD and stroke (costing US$1060-US$10,340 per DALY averted) become more efficient when delivered in integrated packages. At an annual willingness-to-pay (WTP) level of about US$3 million, a package consisting of aspirin, streptokinase, ACE-inhibitor and beta-blocker for AMI has the highest probability of being most cost-effective, whereas as WTP increases to > US$7 million, combination drug treatment to individuals having >35 % absolute risk stands out as the most cost-effective strategy. Cost-effectiveness ratios were relatively more sensitive to halving the effectiveness estimates as compared with doubling the price of drugs and laboratory tests.
  
  
  CONCLUSIONS
  In Ethiopia, the escalating burden of CVD and its risk factors warrants timely action. We have demonstrated that selected CVD intervention packages could be scaled up at a modest budget increase. The level of willingness-to-pay has important implications for interventions' probability of being cost-effective. The study provides valuable evidence for setting priorities in an essential healthcare package for CVD in Ethiopia.
authors.affiliation: Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Mieraf Taddesse
authors.initials: MT
authors.lastname: Tolla
authors.affiliation: Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Ole Frithjof
authors.initials: OF
authors.lastname: Norheim
authors.affiliation: Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Solomon Tessema
authors.initials: ST
authors.lastname: Memirie
authors.affiliation: Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Senbeta Guteta
authors.initials: SG
authors.lastname: Abdisa
authors.affiliation: Federal Ministry of Health (FMOH), Addis Ababa, Ethiopia.
authors.forename: Awel
authors.initials: A
authors.lastname: Ababulgu
authors.affiliation: Management Science for Health, Addis Ababa, Ethiopia.
authors.forename: Degu
authors.initials: D
authors.lastname: Jerene
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Melanie
authors.initials: M
authors.lastname: Bertram
authors.affiliation: Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Strand
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
authors.affiliation: Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Kjell Arne
authors.initials: KA
authors.lastname: Johansson
keywords: Cardiovascular disease; Cost-effectiveness analysis; Ethiopia; Ischemic heart disease; Prevention; Stroke; Treatment