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    Which interventions offer best value for money in primary prevention of cardiovascular disease?

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    53
    Author
    Cobiac, LJ; Magnus, A; Lim, S; Barendregt, JJ; Carter, R; Vos, T
    Date
    2012
    Source Title
    PLoS One
    Publisher
    Public Library of Science (PLoS)
    University of Melbourne Author/s
    COBIAC, LINDA
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Cobiac, L. J., Magnus, A., Lim, S., Barendregt, J. J., Carter, R. & Vos, T. (2012). Which interventions offer best value for money in primary prevention of cardiovascular disease?. PLoS One, 7 (7), pp.e41842-. https://doi.org/10.1371/journal.pone.0041842.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/259977
    DOI
    10.1371/journal.pone.0041842
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402472
    Abstract
    BACKGROUND: Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease. METHODS AND FINDINGS: In a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit. CONCLUSIONS: There is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.

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