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Nutrition and Coronary Heart Disease

they were calculated using a similar method. The safest method for this type of
comparison is to only use epidemiological evidence from the papers and rework the
costs based on current information to allow a more relevant figure to be calculated.
With this word of warning in mind, Weinstein and Stason (1985) concluded that the
treatment of moderate to severe hypertension appears to be an efficient use of medical
resources, whereas the treatments of mild hypertension and cholesterol are less efficient.

Kritiansen, Eggen and ThelIe (1991)

Kritiansen, Eggen and Thelle (1991) focussed on the cost-effectiveness of programs that
are designed to reduce CHD through interventions aimed at lowering serum cholesterol.
Furthermore, programs are examined incrementally. That is, the focus is on the
marginal costs and benefits of a three-stage approach aimed at reducing cholesterol.
The three interventions were:

• population-based promotion aimed at better eating habits;

•      individual dietary programs following screening; and

•      cholesterol lowering drugs.

Kritiansen, Eggen and Thelle (1991) followed the methods OfWeinstein and Stason
(1985) in calculating the net treatment costs of the interventions. Costs and benefits
were measured over a twenty-year period, with the costs being discounted at a rate of
7% per annum.

Kritiansen, Eggen and Thelle (1991) assumed that the population-based program lead to
a reduction of serum cholesterol levels of 5%. Individual counselling on diet in
combination with the population-based programs was assumed to lead to a total
reduction of serum cholesterol of 10%. Finally, it was assumed that the average
reduction in serum cholesterol induced by the addition of cholesterol lowering drugs to
the above two interventions was 20%.

Further, Kritiansen, Eggen and Thelle (1991) assumed a sliding effectiveness of the
reduction of cholesterol on the rates of CHD. They assumed that a 1% reduction would
reduce the risk of CHD by 2% for those with concentrations of 5-5.9 mmol∕l, by 2.5% at
the 6-7.9 mmol/1 and by 3% for those with cholesterol levels above 7.9 mmol∕l.

CHERE Project Report 11- November 1999

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