Measuring the costs and benefits of heart disease monitoring

Objective-To evaluate the costs and benefits of alternative systems of coro nary heart disease monitoring in Scotland. Design-An option appraisal was conducted to evaluate the costs and benefits of implementing a coronary heart disease monitoring system. This involved a review of existing Scottish datasets and relevant reports, specification of options, definition and weighting of benefit criteria by key stakeholder s, assessment of options by experts, and costing of options. The options we re assessed by 33 stakeholders (grouped as cardiologists, patient represent atives, general practitioners, public health physicians, and policy makers) , plus 13 topic experts. Setting-Scotland (population 5.1 million). Results-Between group mean benefit weights were: mortality rates and case f atality (10.6), quality of life (9.8), patient function (8.8), hospital act ivity (7.8), primary care activity (9.25), prescribing (5.72), socioeconomi c impact (4.0), risk factors (7.4), prevalence (5.0), incidence (6.0), case registration (6.82), international comparability (4.2), breadth of coverag e (8.8), and frequency (5.8). Differences between group weights were signif icant for prevalence (p = 0.048) and international comparability (p = 0.032 ). Four monitoring options were identified: a community epidemiology, model , based on MONICA (monitoring trends and determinants in cardiovascular dis ease) study methodology applied to a series of eight representative communi ties, had the highest benefits, at an average annual discounted cost of app roximately pound 360 000; models based on the Australian cardiovascular dis ease monitoring scheme and on enhanced routine data offered fewer benefits at discounted average annual costs ranging from pound 165 000 to pound 195 000; finally, a coronary heart disease registry modelled on the Scottish Ca ncer Registry scheme would have had fewer benefits and substantially higher costs than the other options. Conclusions-The most beneficial coronary heart disease monitoring system is the community epidemiology model, based on MONICA methodology. Option appr aisal potentially offers an explicit and transparent methodology for eviden ce based policy development.