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Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study

BMJ 2011; 343 doi: (Published 28 July 2011) Cite this as: BMJ 2011;343:d4044
  1. Pelham Barton, reader in mathematical modelling1,
  2. Lazaros Andronis, research fellow1,
  3. Andrew Briggs, W R Lindsay chair in health policy and economic evaluation2,
  4. Klim McPherson, visiting professor of public health epidemiology3,
  5. Simon Capewell, professor of clinical epidemiology4
  1. 1Health Economics Unit, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
  2. 2Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
  3. 3New College, University of Oxford, Oxford OX1 2JD, UK
  4. 4Public Health Department, University of Liverpool, Liverpool L69 3GB, UK
  1. Correspondence to: P Barton p.m.barton{at}
  • Accepted 13 May 2011


Objective To estimate the potential cost effectiveness of a population-wide risk factor reduction programme aimed at preventing cardiovascular disease.

Design Economic modelling analysis.

Setting England and Wales.

Population Entire population.

Model Spreadsheet model to quantify the reduction in cardiovascular disease over a decade, assuming the benefits apply consistently for men and women across age and risk groups.

Main outcome measures Cardiovascular events avoided, quality adjusted life years gained, and savings in healthcare costs for a given effectiveness; estimates of how much it would be worth spending to achieve a specific outcome.

Results A programme across the entire population of England and Wales (about 50 million people) that reduced cardiovascular events by just 1% would result in savings to the health service worth at least £30m (€34m; $48m) a year compared with no additional intervention. Reducing mean cholesterol concentrations or blood pressure levels in the population by 5% (as already achieved by similar interventions in some other countries) would result in annual savings worth at least £80m to £100m. Legislation or other measures to reduce dietary salt intake by 3 g/day (current mean intake approximately 8.5 g/day) would prevent approximately 30 000 cardiovascular events, with savings worth at least £40m a year. Legislation to reduce intake of industrial trans fatty acid by approximately 0.5% of total energy content might gain around 570 000 life years and generate NHS savings worth at least £230m a year.

Conclusions Any intervention that achieved even a modest population-wide reduction in any major cardiovascular risk factor would produce a net cost saving to the NHS, as well as improving health. Given the conservative assumptions used in this model, the true benefits would probably be greater.


  • Contributors: PB and LA designed and implemented the model with advice from KMcP, AB, and SC. SC drafted the first and final versions of the manuscript and led the submission and revision process. All authors contributed to the drafting and approval of the final manuscript. PB is the guarantor.

  • Funding: PB and LA were funded by NICE. KMcP, AB, and SC were all members of the NICE Programme Development Group on cardiovascular disease prevention in populations. However, the conclusions do not necessarily reflect official NICE views. West Midlands Health Technology Assessment Collaboration (WMHTAC) and Peninsula Technology Appraisal Group (PenTAG) were funded to provide support to the NICE Centre for Public Health Excellence (CPHE).

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare no support from any organisation apart from NICE for the submitted work. PB and LA were funded by NICE. WMHTAC and Peninsula Technology Appraisal Group (PenTAG) were funded to provide support to the NICE CPHE. KMcP, AB, and SC were all members of the NICE Programme Development Group on CVD prevention in populations.

  • Ethical approval: Not needed.

  • Data sharing: No additional data available.

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