Prevention of cardiovascular diseases in Nairobi slums: a cost-effectiveness study

BackgroundCardiovascular diseases (CVDs) are the main cause of death in sub-Saharan Africa and continue to increase as a result of urbanisation. Presently, national health systems are weak and cannot cope with this epidemic because of the burden of infectious diseases, especially in slum settlements where access to health care and resources are limited. We developed a model for cost effective and affordable prevention of CVDs in slums.MethodsWe analysed results from prevalence and intervention studies of CVDs, including outcomes, from the slums of Nairobi, and focus group discussion with key informants at the study site. We developed an intervention model based on the estimated costs and health benefits, which were systematically scrutinised. We did the cost-effectiveness analysis according to the WHO framework.FindingsCost-effectiveness of CVD prevention was US$760–1200 per disability-adjusted life-year averted. A reduction in blood pressure among patients with hypertension by 15 mmHg through drug treatment and 1 mmHg through health promotion, will prevent 15–24 events in the next 10 years, which results in 248–391 disability-adjusted life-years averted. The total costs of the programme would be $305 000 over a period of 10 years among 35 000 residents, therefore the programme could cost less than $1 per person per year.InterpretationCompared with other CVD prevention projects in low-resource settings, this project has the potential to be one of the most cost-effective and affordable for governments and non-governmental organisations to implement in low-resource settings.FundingAcademic Medical Center Amsterdam Foundation.