Prevention of coronary heart disease: Incremental cost effectiveness raises issues

doi:10.1136/bmj.328.7436.405-a

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

Letter

Prevention of coronary heart disease

Incremental cost effectiveness raises issues

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

EDITOR—Marshall seemed not to include the cost to thehealth system of treatment after a myocardial infarction occurs.¹You could go further and estimate the cost to society of prematurelylosing productive members.

Say, for example, one myocardial infarction was prevented withtreatment A and two with treatment B in a group of 100. If Acosts $1 a year and B, $10, then A would be five times as costeffective as B per event prevented. However, if the cost oftreatment after an event occurs is high, B could be more costeffective. If they operate independently A and B together couldbe the best treatment.

Marshall might have discussed what dosages of statins were used.In the United States the cost is fairly constant with dose,but the effectiveness for a given patient could change and sowould the cost effectiveness.

Marshall assumed a patient . . . [Full text of this article]

William C D'Avanzo, retired

21B Kenneth Stuart Place, Mohegan Lake, NY 10547 davanzo@prodigy.net

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Coronary heart disease prevention: insights from modelling incremental cost effectiveness: Tom Marshall
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