Prevention of coronary heart disease

doi:10.1136/bmj.328.7436.405-a

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Incremental cost effectiveness raises issues

William C D'Avanzo, retired (davanzo@prodigy.net)

21B Kenneth Stuart Place, Mohegan Lake, NY 10547

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

Say, for example, one myocardial infarction was prevented with treatment A and two with treatment B in a group of 100. If A costs $1 a year and …