When is an ounce of prevention worth a pound of cure: The case of cardiovascular disease?

Objective: To provide decision makers with a tool to inform resource allocation decisions at the local level, using cardiovascular disease prevention as an example. Method: Evidence from the international literature was extrapolated to estimate the health and financial impacts in Central Sydney Area Health Service (CSAHS) of three different prevention programs; smoking cessation; blood pressure reduction and cholesterol lowering. The cost-effectiveness analysis framework was reconfigured to 1) estimate the risk of CVD in the community using local risk factor data, 2) estimate the number of CVD events prevented through investment in preventive programs and 3) estimate the local financial flow-on effects of prevention on acute care services. The model developed here estimates an upper bound of what local decision makers could spend on preventive programs whilst remaining consistent with their willingness to pay for one additional life-year gained. Results: The model predicted that over a five-year period the cumulative impact of the three programs has the potential to save 1245 life-years in people aged 40-79 years living in CSAHS. If decision-makers are willing to invest in cost-saving preventive programs only, the model estimates that they can spend up $12 per person in the target group per year. However, if they are willing to spend $70,000 per life-year gained, this amount rises to $201. Conclusions: Modelling the impact of preventive activities on the acute care health system enables us to estimate the amount that can be spent on preventive programs. The model is flexible in terms of its ability to examine these impacts in a variety of settings and therefore has the potential to be a useful resource planning tool.