Cost-effectiveness of Interventions to Control Cardiovascular Diseases and Diabetes in Low- and Middle- Income Countries

Philippines Conference Room
Encina Hall, Third Floor, Central, C330
616 Jane Stanford Way, Stanford, CA 94305
  • Kavita Singh

More than 80% of cardiovascular diseases (CVD) and diabetes mellitus (DM) burden now lies in low and middle-income countries. Thus, there is an urgent need to identify and implement the most cost-effective interventions, particularly in the resource-constraint South Asian settings. A 2018 systematic review evaluated the cost-effectiveness of individual-level, group-level and population-level interventions to control CVD and DM in South Asia. Of the 2949 identified studies through a search of 14 electronic databases up to 2016, 42 met full inclusion criteria. Critical appraisal of studies revealed 15 excellent, 18 good and 9 poor quality studies. Most studies were from India (n=37), followed by Bangladesh (n=3), Pakistan (n=2) and Bhutan (n=1). The economic evaluations were based on observational studies (n=9), randomised trials (n=12) and decision models (n=21). Together, these studies evaluated 301 policy or clinical interventions or combination of both. We found a large number of interventions were cost-effective aimed at primordial prevention (tobacco taxation, salt reduction legislation, food labelling and food advertising regulation), and primary and secondary prevention (multidrug therapy for CVD in high-risk group, lifestyle modification and metformin treatment for diabetes prevention, and screening for diabetes complications every 2–5 years). Significant heterogeneity in analytical framework and outcome measures used in these studies restricted meta-analysis and direct ranking of the interventions by their degree of cost-effectiveness. The cost-effectiveness evidence for CVD and DM interventions in South Asia is growing, but most evidence is from India and limited to decision modelled outcomes. There is an urgent need for formal health technology assessment and policy evaluations in South Asia and other low- and middle- income countries using local research data.

I am Dr. Kavita Singh, interested in global cardiometabolic disease epidemiology and economic evaluations of interventions for prevention and control of chronic diseases in low- and middle- income countries. I am an Epidemiologist by training, and work as a research scientist at the Public Health Foundation of India. My research work has primarily focused on evaluating the long-term effectiveness and cost-effectiveness of a multicomponent quality improvement intervention (consisting of decision-support electronic health records to enhance physician’s responsiveness and care coordinators to improve patient’s adherence to therapy) in 1,146 patients with type 2 diabetes attending 10 tertiary care clinics in India and Pakistan as part of the National Heart Lung Blood Institute funded CARRS Trial. Recently, I have been awarded the Emerging Global Leader Award (K43 grant, 2019-2024), funded by the National Institutes of Health, Fogarty International Centre to conduct a research project that aims to develop and test the feasibility of a multicomponent cardiovascular quality improvement strategy for patients with established cardiovascular diseases (CVD) in India.