COST-EFFECTIVENESS OF CORONARY HEART-DISEASE PREVENTION STRATEGIES INADULTS

Although risk-factor modification has gained wide acceptance as an eff ective approach to the prevention of coronary heart disease (CHD), hea lth planners, physicians and patients confront considerable uncertaint y over the most appropriate and efficient preventive strategies. Some preventive approaches are both inexpensive and effective; others are e xpensive while their effectiveness is slight or unproven. Effectivenes s varies with an individual's age, gender and other risk factors. Info rmation provided by a cost-effectiveness analysis can clarify the valu e of alternative strategies for CHD prevention in specific populations , thereby helping to choose among them. It does so by producing a stan dard measure of value - the cost per year of life saved (YLS) or cost per quality-adjusted life-year (QALY) saved - that reveals which of se veral alternative interventions provides the greatest health benefit f rom a given expenditure. This article summarises the extensive literat ure on the cost effectiveness of CHD prevention with an emphasis on pr imary prevention. Published work indicates that smoking-cessation prog rammes, particularly those that rely on counselling with or without ni cotine supplements, are highly cost effective in many settings. Althou gh the evidence is limited, exercise programmes also appear to be cost effective, The detection and treatment of hyper tension is highly cos t effective, particularly when inexpensive drugs with proven effective ness, such as diuretics or beta-blockers, are used. Hormone-replacemen t therapy is a cost-effective approach to CHD prevention in most postm enopausal women, although direct clinical trial data are lacking and i t is uncertain which hormone preparation is best. Cholesterol reductio n is a cost-effective strategy for the prevention of CHD in individual s without other treatable risk factors who are at very high risk of de veloping CHD. For individuals with multiple CI-ID risk factors, the ch oice of risk-modification strategies is complex and depends upon the i nteractions of risk and the relative costs of treating each risk.