STRATEGIES FOR REDUCING CORONARY RISK-FACTORS IN PRIMARY-CARE - WHICHIS MOST COST-EFFECTIVE

Objective-To examine the relative cost effectiveness of a range of scr eening and intervention strategies for preventing coronary heart disea se in primary care. Subjects-7840 patients aged 35-64 years who were p articipants in a trial of modifying coronary heart disease Ask factors in primary care. Design-Effectiveness of interventions assumed and th e potential years of life gained estimated from a risk equation calcul ated from Framingham study data. Main outcome measure-The cost per yea r of life gained. Results-The most cost effective strategy was minimal screening of blood pressure and personal history of vascular disease, which cost pound 310-pound 930 per year of life gained for men and po und 1100-pound 3460 for women excluding treatment of raised blood pres sure. The extra cost per life year gained by adding smoking history to the screening was pound 400-pound 6300 in men. AU strategies were mor e cost effective in men than in women and more cost effective in older age groups. Lipid lowering drugs accounted for at least 70% of the es timated costs of all strategies. Cost effectiveness was greatest when drug treatment was limited to those with cholesterol concentrations ab ove 9.5 mmol/l. Conclusions-Universal screening and intervention strat egies are an inefficient approach to reducing the coronary heart disea se burden. A basic strategy for screening and intervention, targeted a t older men with raised blood pressure and limiting the use of cholest erol lowering drugs to those with very high cholesterol concentrations would be most cost effective.