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Primary prevention of certain cardiovascular risk factors in older subjects yields improved health at low relative cost, analysis suggests

Tuesday, October 27 2009 | Comments

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What's This? Focusing on primary prevention of cardiovascular risk factors could lead to notable improvements in the health of older Americans at a relatively low cost, even though longevity would increase, researchers concluded after conducting a cost-benefit analysis.

The dynamic simulation model tracked individuals aged 51 or 52 years to determine the health benefits and medical cost savings resulting from successful treatment of 4 cardiovascular risk factors--obesity, diabetes, hypertension, and smoking--under different prevention scenarios.

They applied the model to the 1,028 participants of the 2004 Health and Retirement Study (HRS), a biennial survey initiated in 1992 among subjects aged at least 51 years. The researchers supplemented the HRS data with findings from the 2002-2004 Medicare Current Beneficiary Survey and 2002-2004 Medical Expenditure Panel Survey to model medical spending and quality of life.

They determined the impact of lifetime prevention of obesity, diabetes, hypertension, and smoking assuming successful preventive treatment for 10%, 25%, 50%, and 100% of the at-risk population for each of the four conditions. However, they noted that while achieving a 100% rate of success was "certainly not feasible," this level of success is significant from a policy standpoint as decisions are made regarding which diseases to target.

Assuming a 100% effective treatment scenario, primary prevention would yield a 0.85-year gain in life span for a person aged 51 or 52 years with obesity, a gain of 3.17 years for a patient with diabetes, 2.05 years for a hypertension patient, and 3.44 years for an individual who smoked.

The model showed that even though individuals would have longer lives, successful preventive treatment would still result in lower lifetime medical spending, exclusive of prevention costs, with respective savings of $7,168, $34,483, and $13,702 for patients with obesity, diabetes, and hypertension. Conversely, smoking cessation would cost an additional $15,959 during an individual's lifetime.

"Thus, for persons treated with diabetes, hypertension, and obesity interventions, life extension could be achieved without increasing average lifetime medical spending," the investigators remarked.

Assuming each quality-adjusted life-year was worth a conservative $100,000, they determined net economic benefits per treated 51- or 52-year-old individual of approximately $51,750 for obesity, $198,018 for diabetes, $137,94 for hypertension, and $118,946 for smoking.

Regarding the feasibility of prevention, existing treatments for diabetes, hypertension, and smoking have demonstrated efficacy, but the authors of the study pointed out that interventions for obesity are less promising.

"Greater attention should be paid to the development and implementation of more effective prevention strategies as a way to immediately address demographic shifts that are about to transform the landscape of human health and longevity," the researchers concluded. (Goldman DP, et al. Am J Public Health 2009;99:2096-2101.)

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