Prioritization of Intervention Domains to Prevent Cardiovascular Disease: A Country-Level Case Study using Global Burden of Disease and Local Data
Abstract Aim: We aimed to combine Global Burden of Disease (GBD) Study data and local data to identify the highest priority intervention domains for preventing cardiovascular disease (CVD) in the case study country of Aotearoa New Zealand (NZ). Methods: Risk factor data for CVD in NZ was extracted from the GBD using the “GBD Results Tool”. We prioritized risk factor domains based on consideration of the size of the health burden (disability-adjusted life years [DALYs]) and then by two alternative ways: (i) strength of the evidence-base for domain-specific interventions being cost-saving (based on number of NZ publications); and (ii) the domain-specific interventions that delivered the highest health gains and cost-savings. Results: Based on the size of the CVD health burden in DALYs, the five top prioritized risk factor domains were: high systolic blood pressure (84,800 DALYs; 5400 deaths in 2019), then dietary risk factors, then high LDL cholesterol, then high BMI and then tobacco (30,400 DALYs; 1400 deaths). When considering strength of evidence-base around health economic benefits, we found that tobacco control could be considered to be the highest priority risk factor domain to intervene in (nine NZ publications showing cost-savings). But if policy-makers aimed to maximize health gain and cost-savings from specific interventions that have been studied, then they would favor the dietary risk domain (e.g., a combined fruit and vegetable subsidy plus a sugar tax produced estimated lifetime savings of 894,000 health-adjusted life years and health system cost-savings of US$11.0 billion). Other potential considerations for prioritization are: (i) the potential for total health gain that includes non-CVD health loss (i.e., again favoring tobacco control); (ii) potential for achieving relatively greater per capita health gain for Māori (Indigenous) to reduce health inequities; and (iii) consideration of co-benefits such as greenhouse gas reductions from dietary interventions. Conclusions: We were able to show how CVD risk factor domains could be systematically prioritized using a mix of GBD and country-level data. Tobacco control could be top ranked if policy-makers focused on the strength of evidence for health economic benefits. But if policy-makers wished to maximize health gain and cost-savings from any specific intervention/s, then they may favor dietary interventions e.g., food taxes and subsidies..
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Preprint| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
ResearchSquare.com - (2023) vom: 16. Okt. Zur Gesamtaufnahme - year:2023 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Wilson, Nick [VerfasserIn] |
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| doi: |
10.21203/rs.3.rs-1451404/v1 |
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XRA035508744 |
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| 520 | |a Abstract Aim: We aimed to combine Global Burden of Disease (GBD) Study data and local data to identify the highest priority intervention domains for preventing cardiovascular disease (CVD) in the case study country of Aotearoa New Zealand (NZ). Methods: Risk factor data for CVD in NZ was extracted from the GBD using the “GBD Results Tool”. We prioritized risk factor domains based on consideration of the size of the health burden (disability-adjusted life years [DALYs]) and then by two alternative ways: (i) strength of the evidence-base for domain-specific interventions being cost-saving (based on number of NZ publications); and (ii) the domain-specific interventions that delivered the highest health gains and cost-savings. Results: Based on the size of the CVD health burden in DALYs, the five top prioritized risk factor domains were: high systolic blood pressure (84,800 DALYs; 5400 deaths in 2019), then dietary risk factors, then high LDL cholesterol, then high BMI and then tobacco (30,400 DALYs; 1400 deaths). When considering strength of evidence-base around health economic benefits, we found that tobacco control could be considered to be the highest priority risk factor domain to intervene in (nine NZ publications showing cost-savings). But if policy-makers aimed to maximize health gain and cost-savings from specific interventions that have been studied, then they would favor the dietary risk domain (e.g., a combined fruit and vegetable subsidy plus a sugar tax produced estimated lifetime savings of 894,000 health-adjusted life years and health system cost-savings of US$11.0 billion). Other potential considerations for prioritization are: (i) the potential for total health gain that includes non-CVD health loss (i.e., again favoring tobacco control); (ii) potential for achieving relatively greater per capita health gain for Māori (Indigenous) to reduce health inequities; and (iii) consideration of co-benefits such as greenhouse gas reductions from dietary interventions. Conclusions: We were able to show how CVD risk factor domains could be systematically prioritized using a mix of GBD and country-level data. Tobacco control could be top ranked if policy-makers focused on the strength of evidence for health economic benefits. But if policy-makers wished to maximize health gain and cost-savings from any specific intervention/s, then they may favor dietary interventions e.g., food taxes and subsidies. | ||
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