Prioritizing risk factors to identify preventive interventions for economic assessment
Nick Wilson, Tony Blakely, Rachel H Foster, David Hadorn & Theo Vos
Volume 90, Number 2, February 2012, 88-96
Table 2. Highest contributors to disability-adjusted life years (DALYs) in high-income countries of the Western Pacific Region of the World Health Organization (WHO) and evidence of availability of cost-effective interventions to prevent them
|Risk factor||Evidence of availability of cost-effective preventive interventionsa||Retain for equity analysisb|
|Tobacco use||Examples: tobacco tax raises
|Alcohol use||Examples: alcohol tax raises; restrictions on alcohol advertising; restriction of the number of sale outlets.
|High blood pressurec||Examples: community heart health programmes; reduction of salt in processed foods
|High blood glucose||ACE-Prevention researchers in Australia found evidence that 5 out of 7 interventions against “pre-diabetes” were cost-effective (i.e. cost < A$ 50 000 [US$ 49 465] per DALY averted), but all at a median cost of ≥ A$ 21 000 (US$ 20 775) per DALY averted.
|Overweight and obesity||Examples: a 10% tax on unhealthy foods (high fat/high sugar foods & drinks); reduction of television advertising; traffic light nutrition labelling (colour-coded symbols to indicated healthy vs unhealthy foods); diet and physical activity programmes.
|Physical inactivity||Examples: mass-media-based campaigns; community programmes to encourage use of pedometers; “green prescriptions” from general practitioners; referral by general practitioners to exercise physiologists.
|High blood cholesterolc||Examples: community heart health programmes; promotion of food products with plant sterols; expanded use of statins; use of a polypilld (depending on price and risk groups).
|Occupational risks||While occupational programmes can yield substantial health benefits, they are generally occupation-specific and not easily included in a risk-factor-based modelling approach.f A population-wide SunSmart programme was found to be cost-saving in Australia,
|Low fruit & vegetable intake||There is evidence favouring certain types of community-based activities that promote fruit and vegetable consumption (in Australian work: 1 intervention was cost-saving, 3 cost-effective, but 19 were not cost-effective).
|Urban outdoor air pollution||Evidence suggests that air pollution can be reduced through regulations on industrial emissions (and, in the United States of America
A$, Australian dollars.
a Bold typeface indicates that evidence of the intervention being cost-saving also exists.
b The results of this analysis are shown in Table 3.
c ACE-Prevention work in Australia combined these topic areas.1
d A low-cost polypill that combines three blood-pressure-lowering drugs and one cholesterol-lowering drug1 (or a similar alternative combination that includes aspirin).16
e This is a national system, first established in law in 2008, for putting a price on greenhouse gas emissions. It allows trading of emissions permits (carbon credits) by industries. Forest planting (a “carbon sink”) can be used to earn credits.
f Smoke-free workplaces are a possible exception, but there is limited scope for expanding this in New Zealand. Improved control of alcohol use may reduce the risk of occupational injury but is more appropriately considered part of alcohol control interventions.