| dc.description.abstract | Background: According to official data, 43% of deaths in Iran are related to cardiovascular diseases (CVD), perceived to be the main cause of Iranian deaths. In 2014, IraPEN program was launched to screen and offer primary prevention of CVDs to all individuals older than 40. In this program, people are detected before the disease, or at its early stages, and treated, using the World Health organization (WHO) risk-based approach for four CVD risk levels. Objective: The main objective of this thesis is to measure the potential cost-effectiveness (CE) of IraPEN preventive actions in comparison with status que (no prevention). Methods: The cost-effectiveness analysis was conducted from a healthcare perspective using two Markov models: “CVD risk with diabetes” and “CVD risk without diabetes” with the 40-year time horizon. Based on the WHO CVD risk prediction, four index cohorts were constructed as low, moderate, high and very high risk groups. All relevant direct medical costs were considered. Costs and effects were discounted at 3.5% per year. Life years (LY) gained and quality-adjusted life year (QALY) were used as the outcome measures and 1 GDP per capita which equals to US$5,494 was assumed as the CE threshold. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted to assess the robustness of the models’ results. Results: The intervention yielded an ICER of $804, $551 and -$44 for moderate, high and very high CVD risk groups without diabetes respectively. These groups gained 0.69, 0.96 and 1.45 life-years respectively. IraPEN’s preventive procedures were highly cost effective for all diabetic patients regardless of their CVD risk group. The results demonstrated an ICER of $711, $630, -$42 and -$71 for low, moderate, high and very high CVD groups with diabetes while they gained 0.46, 1.20, 2.04, and 2.29 years from the intervention. Conclusion: IraPEN program was highly cost-effective for all CVD risk levels except for the low CVD risk group. The results demonstrate that the program is cost saving while improving health if only targets the very high CVD risk group without diabetes as well as high and very high CVD risk groups of diabetic patients. | eng |