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Recent Studies Demonstrate Ways to Improve Quality of Care and Reduce Costs

Thomas Gaziano

With a theme of “Noncommunicable Diseases: The Growing Burden,” the latest issue of Health Affairs features two studies co-led by BWH’s Thomas Gaziano, MD, of the Cardiovascular Division, and a team of authors.

The first study finds that cardiovascular disease screening by community health workers can be cost-effective in low resource countries. Understanding that a physician is not always available in low-resource settings, the authors demonstrated that community health workers can efficiently screen adults for cardiovascular disease in South Africa, Mexico and Guatemala. By using a paper-based or mobile phone-based screening tool that does not require blood testing, community health workers could conduct screenings in a cost-effective, or even cost-saving, manner in all three countries, compared to the usual clinic-based screening. “Our modeling indicated that screening by community health workers, combined with improved treatment rates, would increase the number of deaths averted from 15,000 to 110,000, compared to standard care,” write the authors.

The second study investigates the health and economic impacts of increasing prescription length for statins in South Africa, where the rates of statin use are among the lowest in the world.   “Almost five percent of the country’s total mortality has been attributed to high cholesterol levels, fueled in part by low levels of statin adherence,” write the authors.

They found that increasing prescription length from the standard 30 days to 60 or 90 days could save 1,694 or 2,553 lives per million adults, respectively. In addition, annual per patient costs related to cardiovascular disease would decrease by $152.41 and $210.29, respectively. “Increasing statin prescription length would both save resources and improve health outcomes in South Africa,” conclude the authors.

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Researchers Study Statin Use in India

Medications—along with diet, exercise, and smoking cessation—are a cornerstone of cardiovascular risk reduction. The use of statins, which are the medication of choice for prevention, has increased substantially in North America and Europe over the past three decades, and as a result, cholesterol levels and cardiovascular mortality have decreased.

But little is known about statin use in lower-income countries. BWH researchers recently conducted an observational study of statin use in India, which has the highest burden of cardiovascular disease among less-developed nations.

The researchers found that only a fraction of those eligible for a statin actually received the therapy, despite the wide variety of statins that are available to Indian consumers.

“Low rates of statin use in India may reflect problems with access to health care, affordability, under-diagnosis, and cultural beliefs,” said Niteesh Choudhry, MD, PhD, of the BWH Division of Pharmacoepidemiology and Pharmacoeconomics, and lead author of the paper. “Because of the growing burden of cardiovascular disease in lower-income countries such as India, there is an urgent need to increase statin use and ensure access to safe products whose use is based on evidence.” Continue reading “Researchers Study Statin Use in India”