%0 Journal Article
%T Targeted versus universal prevention. a resource allocation model to prioritize cardiovascular prevention
%A Talitha L Feenstra
%A Pieter M van Baal
%A Monique AM Jacobs-van der Bruggen
%A Rudolf T Hoogenveen
%A Geert-Jan Kommer
%A Caroline A Baan
%J Cost Effectiveness and Resource Allocation
%D 2011
%I BioMed Central
%R 10.1186/1478-7547-9-14
%X A mathematical programming model was developed to calculate optimal allocations for the Dutch population of the following interventions: smoking cessation support, diet and exercise to reduce overweight, statins, and medication to reduce blood pressure. Outcomes were total lifetime health care costs and QALYs. Budget sizes were varied and the division of resources between the general population and diabetes patients was assessed.Full implementation of all interventions resulted in a gain of 560,000 QALY at a cost of ?640 per capita, about ?12,900 per QALY on average. The large majority of these QALY gains could be obtained at incremental costs below ?20,000 per QALY. Low or high budgets (below ?9 or above ?100 per capita) were predominantly spent in the general population. Moderate budgets were mostly spent in diabetes patients.Major health gains can be realized efficiently by offering prevention to both the general and the diabetic population. However, a priori setting a specific distribution of resources is suboptimal. Resource allocation models allow accounting for capacity constraints and program size in addition to efficiency.Lifestyle risk factors, especially a high body weight, play an important role in the development of diabetes [1,2]. Due to ongoing ageing and unfavourable trends in lifestyle in the population diabetes prevalence is increasing rapidly [3,4]. Diabetes patients risk a number of micro and macro vascular complications, with 40 to 56% of the patients suffering from one or more of these. Macrovascular complications are responsible for the majority of complication related use of health care and consist of cardiovascular disease and stroke [5]. Prevention aiming at the reduction of cardiovascular risks has therefore the potential to reduce the burden of diabetes [6,7] and is included in current diabetes guidelines. However, given the prevalence of cardiovascular disease in the general population, it seems also worthwhile to introduce similar preve
%U http://www.resource-allocation.com/content/9/1/14