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Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study

BMJ 2012; 344 doi: (Published 02 March 2012) Cite this as: BMJ 2012;344:e607
  1. Mónica Ortegón, researcher1,
  2. Stephen Lim, associate professor of global health2,
  3. Dan Chisholm, health economist3,
  4. Shanthi Mendis, coordinator4
  1. 1School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
  2. 2Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
  3. 3Department of Health Systems Financing, World Health Organization, Geneva, Switzerland
  4. 4Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva
  1. Correspondence to: M Ortegón Carrera 24 # 63C-69 Bogotá, Colombia monica.ortegon{at}
  • Accepted 26 October 2011


Objective To determine the relative costs and health effects of interventions to combat cardiovascular disease, diabetes, and tobacco related disease in order to guide the allocation of resources in developing countries.

Design Cost effectiveness analysis of 123 single or combined prevention and treatment strategies for cardiovascular disease, diabetes, and smoking by means of a lifetime population model.

Setting Two World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE) and countries in South East Asia with high adult and high child mortality (SearD).

Data sources Demographic and epidemiological data were taken from the WHO databases of mortality and global burden of disease. Estimates of intervention coverage, effectiveness, and resource needs were drawn from clinical trials, observational studies, and treatment guidelines. Unit costs were taken from the WHO-CHOICE (Choosing Interventions that are Cost-Effective) price database.

Main outcome measures Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005.

Results Most of the interventions studied were considered highly cost effective, meaning they generate one healthy year of life at a cost of <$Int2000 (which is the gross domestic product per capita of the two regions considered here). Interventions that offer particularly good monetary value, and which could be considered for prioritised implementation or scale up, include demand reduction strategies of the Framework Convention for Tobacco Control (<$Int950 and <$Int200 per DALY averted in AfrE and SearD respectively); combination drug therapy for people with a >25% chance of experiencing a cardiovascular event over the next decade, either alone or together with specific multidrug regimens for the secondary prevention of post-acute ischaemic heart disease and stroke (<$Int150 and <$Int230 per DALY averted in AfrE and SearD respectively); and retinopathy screening and glycaemic control for patients with diabetes (<$Int2100 and <$Int950 per DALY averted in AfrE and SearD respectively).

Conclusion This comparative economic assessment has identified a set of population-wide and individual strategies for prevention and control of cardiovascular disease that are inexpensive and cost effective in low resource settings.


  • doi: 10.1136/bmj.e586
  • , doi: 10.1136/bmj.e615
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  • Contributors: All authors contributed to the conception, design and interpretation of data. MO and DC performed the technical analysis and drafted the manuscript. All authors approved the submitted version of the manuscript. MO is the guarantor of the manuscript.

  • Funding: None

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • DC and SM are staff members of the WHO. The authors alone are responsible for the views expressed in this publication, and these do not necessarily represent the decisions, policy, or views of the WHO.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

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