**7. Cost effectiveness of cardiovascular disease prevention and treatment**

The highest age standardized death rate from non-communicable diseases (NCDs) (779 per 100, 000) occur mostly in the African Region [35]. In sub Saharan Africa, the probability of dying from NCDs between 30 and 70 years is very high. It is also indicated that behavioral risk factors are estimated to be responsible for about 80% of coronary heart disease and cerebrovascular disease and these include tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol. The cost of implementing reduction measures for tobacco control (smoke-free policies, raise tobacco taxes, package warnings, advertising bans), harmful alcohol consumption, and physical activity and diet modification is found to be low [36]. Usually these costs include media campaigns and overall program management. It is feasible to deliver cardiovascular risk reduction interventions in primary care, even in low-resource settings with non-physician health workers [37]. Currently, there are major gaps in access to these essential primary care interventions in developing countries including in those in sub-Saharan Africa [38].

There are other strategies that can be employed to prevent cardiovascular diseases. This becomes attractive to providers and can lead to policy change. According to recent surveys there is high prevalence of salt consumption [39] in South Africa. The burden of cardiovascular disease (CVD) in the same country is rising, and to address this, the government recently developed policies to reduce salt consumption in the population [39]. Population-based salt reduction strategies have been found to be a cost-effective approach to lowering the prevalence of hypertension and preventing cardiovascular disease (CVD). The cost saving for both household and providers was significantly different. The extended cost-effectiveness analysis (ECEA), which models the health gains, financial risk protection and distributional effects of public policies.

Mathers [40] states that cardiovascular diseases are responsible for about 30% of all deaths worldwide, and total deaths occurring in developing countries amount to about 80% [41]. Several authors have suggested that the combination of several preventive treatments could cut more than half the occurrence of cardiovascular disease [41–43]. The analyses have shown that two multidrug regimens of four highly effective drugs could lead to cost-effective prevention and treatment for patients with cardiovascular disease in all developing regions [44]. Wald and Law [41] specifically proposed a polypill, consisting of a statin, aspirin, a β blocker, an angiotensin-converting-enzyme inhibitor (ACEI), a thiazide, and folic acid. Suggested primary preventive therapy consists of aspirin, ACEI, calcium-channel blocker, and statin. While secondary preventive therapy consists of aspirin, ACEI, β blocker, and statin [41]. If two polypills, consisting of the same drug combinations as the primary and secondary prevention strategies, would also improve adherence, the results would be even more favorable.

In conclusion, these lifestyle modification strategies such as tobacco use control, reduction in harmful effects of alcohol, diet and physical activity and salt intake reduction are perceived to be cost-effective. Primary and secondary preventive treatments are also found to be cost-effective in preventing cardiovascular disease. This can improve on patients quality of life with cost savings.
