BMJ  2004;328:405 (14 February), doi:10.1136/bmj.328.7436.405

Letter

Prevention of coronary heart disease

Is a cure too expensive?

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

EDITOR—As Warburton points out in her editorial, we may soon be able to reduce the event rate in patients at risk of coronary heart disease to towards zero.¹ The current cocktail of drugs is likely to decrease events by up to 88%.²

We have been fortunate that most of the drugs in this cocktail are cheap (aspirin, thiazides, blockers). Marshall in his article shows that aspirin (NHS price £0.18 per 28 days) is much more cost effective than clopidogrel (NHS price £35.31 per 28 days) and statins (NHS price £29.68 per 28 days).³ I doubt that anybody would have been surprised by this finding.

If we continue to pursue new treatments that will reduce the risks of ischaemic heart disease further they will inevitably be much less cost effective than aspirin. As the event rate goes down with each successful intervention the number needed to treat for each . . . [Full text of this article]

King's Mill Hospital, Mansfield MG17 4JL alastaircooke@doctors.org.uk

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