Building healthier communities: effectiveness and cost-sustainability of the ASL3 GENESIS program for chronic diseases prevention

BACKGROUND: Population aging leads to rising chronic disease burden and healthcare costs. The metropolitan area of Genoa (Liguria), the oldest in Italy, is particularly affected. Since 2017, ASL3 has implemented a comprehensive health promotion strategy including risk-factor reduction initiatives and multidisciplinary care pathways for multimorbid patients. AIMS: To evaluate the impact of the comprehensive health promotion program on the prevalence of heart failure (HF), chronic kidney disease (CKD), and chronic liver disease (CLD), and on healthcare resource use. METHODS: Using the ASL3 data warehouse, we analyzed trends in HF, CKD, and CLD prevalence from 2011 to 2023 and compared yearly prevalence between 2011 and 2019 and 2020-2023. Hospitalization, outpatient activity and drug-prescription data were assessed; production and pharmaceutical costs were calculated. Regression models evaluated changes in prevalence trajectories. RESULTS: The resident population and average age increased slightly (from 704,355 to 711,133 people; from 49 to 51 years old). The unadjusted and standardized prevalence of HF, CKD and CLD rose significantly over the study period. However, after regression analysis, significance was confirmed only for the period 2011-2019. In 2020-2023, prevalence continued to rise, but at a substantially slower rate, suggesting an attenuation of the upward trend. CONCLUSIONS: A multifaceted, system-wide prevention and care model may attenuate the upward trend in chronic-disease prevalence in highly aged populations. These findings support integrated health-promotion strategies as a sustainable approach to chronic disease management and resource stewardship.