Risk factor thresholds

doi:10.1136/bmj.325.7372.1114

BMJ 2002;325:1114 ( 9 November )

Letters

Risk factor thresholds

Threshold is £37 000 per QALY

Hypothesis is dangerous nonsense

Pharmacological treatment should not be determined by age alone

Authors' reply

Threshold is £37 000 per QALY

The first 150 words of the full text of this article appear below.

EDITOR $---$ Although I agree with most of Law's and Wald's conclusions with regard to risk factors, I cannot agree that, as a result,treatment thresholds do not exist.¹ With regard to the riskof coronary heart disease, the recent joint British recommendationsrecommend starting treatment of high blood pressure at an absolute10 year risk of coronary heart disease of 15%, and of a high lipidratio at 30%.² Neither these recommendations nor those of theStanding Medical Advisory Committee explain why these particularthresholds have been set. (Neither do they mention when treatmentshould be stopped.) But could or should it have something to dowith cost? I think that, despite the article's title, Law andWald acknowledge this implicitly by saying that people at highrisk should betargeted.

There have been several published cost effectiveness analyses of lipid lowering drugs. The report from Pickin et al puts . . . [Full text of this article]

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