Condition | Intervention | Objective | Cost-effectiveness ratio |
---|---|---|---|
IHD and stroke prevention | Combination treatment with aspirin, β-blocker, thiazide diuretic, ACE inhibitor and statin based on 10-year risk of cardiovascular disease | Primary prevention | US$2128/DALY averted |
Tobacco addiction | Nicotine replacement therapy | Primary prevention | US$396/DALY averted |
Acute MI | Aspirin with or without β-blocker (atenolol) | Acute care | US$14/DALY averted |
Acute MI | Incremental use of streptokinase, in addition to aspirin and β-blocker (atenolol) | Acute care | US$671/DALY averted |
Acute ischaemic stroke | Aspirin dose within 48 hours of onset of acute stroke | Acute care | US$149/DALY averted |
Acute ischaemic stroke | Heparin within 48 hours of onset of stroke or thrombolytic therapy using recombinant tissue plasminogen activator within 3 hours of onset | Acute care | US$1977/DALY averted |
Chronic IHD and stroke | Combination treatment with aspirin, β-blocker, thiazide diuretic, ACE inhibitor and statin, based on 10-year risk of cardiovascular disease | Secondary prevention | US$409/DALY averted |
Chronic IHD | Aspirin plus β-blocker (atenolol), with optional ACE inhibitor (enalapril), with or without hospital availability | Secondary prevention | US$688/DALY averted |
Chronic IHD | Statin (lovastatin), incremental to aspirin, β-blocker (atenolol) and ACE inhibitor (enalapril), with or without hospital availability | Secondary prevention | US$2028/DALY averted |
Chronic poststroke care | Daily aspirin dose or combination of aspirin and extended release dipyridamole | Secondary prevention | US$81/DALY averted |
Chronic poststroke care | Carotid endarterectomy surgery | Secondary prevention | US$1458/DALY averted |
Chronic HF | Use of ACE inhibitor and an optional β-blocker (metoprolol), incremental to diuretics | Secondary prevention | US$150/DALY averted |
Source: Laxminarayan et al.19
Notes: cost-effectiveness ratios are presented in 2006 US dollars. These interventions were selected on the basis of cost-effectiveness ratio of <US$3000/DALY averted (ie, 3× gross domestic product per capita of a typical lower middle-income country).
CVD, cardiovascular disease; DALY, disability-adjusted life-year; HF, heart failure; IHD, ischaemic heart disease; LMIC, low/middle-income country; MI, myocardial infarction.