COST-EFFECTIVENESS OF ALTERNATIVE INTERVENTIONS FOR THE PREVENTION AND TREATMENT OF CORONARY HEART-DISEASE

Although mortality from coronary heart disease (CHD) in Australia has fallen dramatically since the 1960s, it still remains the major cause of death in Australia and poses a significant burden on the economy. E ven though a number of studies have concluded that prevention has been the main determinant of the declines in CHD, a disproportionate amoun t of health-care expenditure is devoted to treatment rather than preve ntion. This paper reviews the international literature on the economic appraisal (costs and benefits) of alternative interventions for the t reatment and prevention of CHD with the view of assessing whether ther e is sufficient evidence to justify a reallocation of resources away f rom treatment to prevention. First, few studies on the economic evalua tion of CHD prevention and treatment programs have been undertaken in Australia, with most being from the United States and Europe. Second, assumptions about the specification, measurement and valuation of cost s, and the epidemiological evidence on program effectiveness have vari ed. Third, health promotion and prevention programs are not necessaril y more cost-effective than drug or surgical treatments for CHD. Indivi dual interventions must be judged on their own merits. There is a need for a systematic evaluation of interventions for CHD using primary Au stralian data to better inform decision making on resource-allocation priorities. Such an evaluation should incorporate economic evaluation techniques.