What do we gain from the sixth coronary heart disease drug?

Not much: guidelines must consider cost effectiveness

From air travel to patient safety to coronary heart disease prevention, people strive to reduce risk to zero. We know that zero risk is unattainable, yet we pursue perfection. It may be useful to hold perfection as an ideal,1 but there can be great harm in trying to achieve it because near perfection often imposes near infinite costs. The closer we get to perfect risk reduction, the more likely it becomes that we could have got a better bang for our preventive buck somewhere else. This applies across all activities–and needs to be heeded in health care as anywhere else.

For example, air travel is already much safer than most other forms of travel, so £10m ($17m; €14m) spent on road safety would save far more life years than £10m put into tightening airport security. Yet since September 11 much new spending has gone into airport security. In health too we often see a rush to perfection without regard for costs. Here are three examples. Firstly, universal precautions to prevent worksite transmission of HIV to healthcare workers have been widely implemented, yet cost …