Bulletin of the World Health Organization

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 4. Our final prioritized list of major risk factors for further cost-effectiveness research on preventive interventions in New Zealand

Risk factors Additional rationale and comment
Six top priority (ranked)
Tobacco use A major contributor to disease burden and especially to health inequalities in New Zealand.
Alcohol use Like tobacco use, this is clearly an important risk factor. Nevertheless, the existence of over 200 three-digit ICD-10 codes for which alcohol is part of a component cause poses a challenge for research.41 Intervention analyses will therefore need to follow the completion of the New Zealand burden of disease study revision that began in 2010.
High blood pressure A risk factor that shares many potential interventions with “high blood cholesterol”.
High blood cholesterol This risk factor was upgraded in priority because interventions targeting it appear more promising than those targeting most of the other risk factors we considered. It is also more relevant than physical inactivity in terms of Māori health (as per years-of-life-lost estimates). Additionally, there is overlap with the blood pressure interventions if an absolute risk approach, such as the use of a polypill, is adopted.
Overweight and obesity An important risk factor (especially for the Māori population), but uncertainty surrounds the persistence of intervention effects.
Physical inactivity An important risk factor but its possible impact on health inequalities is indirect and uncertainty surrounds the persistence of intervention effects (especially in connection with paediatric interventions).
Lower priority
Low fruit and vegetable intake In past work, the benefits of reducing this risk factor may have been overestimated, as suggested by the findings of a recent, very large cohort study.42
High blood glucose This risk factor was assigned relatively lower priority because interventions for blood glucose control do not appear to be particularly cost-effective. Also, this risk factor will be partly covered by interventions targeting other risk factors, such as physical inactivity, overweight and obesity and possibly vegetable intake.43

ICD-10, International Classification of Diseases, 10th revision.