Economic Benefits of Intervention
In the cost-effectiveness analyses, most of the gains are reported in cost savings either from particular interventions, such as decreased hospitalizations resulting from the improved combination therapy of the polypill, or from a more efficient means of screening those at highest risk through an absolute-risk approach. Those who do not die from the sequelae of poorly controlled risk factors for CVD suffer from serious chronic illness, such as stroke and congestive heart failure. Those chronic diseases can result in significant impairments, thereby preventing those affected from continuing to work and sometimes also requiring the services of other family members, who themselves end up having to leave the workforce. Further losses resulting from disability include the loss of wages for major wage earners and their families and the state's losses in terms of disability compensation. Leeder and others (2004) estimate that in 2000 the cost of CVD disability payments in South Africa equaled US$70 million.
However, many other indirect economic gains or losses are not included in the economic analysis, such as gains or losses in productivity. Leeder and others (2004) report that, at current CVD mortality rates, the potential productive years of life lost (defined as those years between the ages of 35 and 64) will nearly double by 2030. Those later adult working years are particularly important, given the many years of investment in skills through formal education and experience that would be lost. Preventing CVD would therefore improve the size and skills of the workforce and would therefore aid economic development. For those reasons, the Commission for Macroeconomics and Health has recommended that any intervention that costs less than triple a country's per capita gross domestic product be regarded as cost-effective (WHO 2001). Many of the combination cardiovascular preventive approaches outlined in this chapter comfortably satisfy that criterion.
