Van Gool & Bridges
The effectiveness measures were based on the number OfNorwegian males aged
between 40 and 49, a number totalling 200 000. The dietary program was aimed at
those who had cholesterol in the range 6-7.9 mmol/1 whereas the combined dietary and
drug treatments were aimed at those with serum cholesterol levels above 7.9 mmol/1.
The authors assumed a 100% participation rate for these programs. This assumption
may lead to an overestimation of the effectiveness measure as the analysis will be
restricted to the biomedical component of the strategy and ignore behavioural
components (see section 5.3 for further discussion).
The discounted total net costs of the population interventions were estimated by
ICritiansen, Eggen and Thelle (1991) to be £12 (1990 pounds) per life year saved for
men aged between 40-49 years. The incremental costs per life year saved for the
screening and dietary intervention was £12,400 and £111,500 for the combined dietary
and drug treatment.
Kritiansen, Eggen and Thelle (1991) also estimated the cost-effectiveness ratios for the
three interventions of £10, £100,546 and £125,860 per QALY, respectively.
From Kritiansen, Eggen and Thelle’s (1991) results, which are based on a large number
of assumptions, it can be concluded that mass media, population wide, interventions are
much more cost effective at reducing the rates of CHD than the other two interventions.
Crowley, Dunt and Day (1995)
The Crowley, Dunt and Day (1995) paper reviewed the international literature on the
cost-effectiveness of alternative interventions in the treatment and prevention of CHD.
The aim was to examine the claim that resources should be moved from treatment to
prevention of CHD. They focused on the three most predominant risk factors for CHD;
smoking, hypertension and Iiypercholesterolaemia, and also considered exercise and
weight-loss programs. However, there was limited evidence for the latter two.
Crowley, Dunt and Day (1995) used the findings OfKristiansen et al (1991), Kinlay et
al (1994), Drummond and McGuire (1990) and Martens et al (1989). They concluded
that the most favourable cost-effectiveness ratios were for the reduction of risk through
cholesterol lowering interventions on a population wide basis. They also noted that
whilst the evidence for cholesterol-lowering drugs reducing CHD mortality is well
Chere Project Report 11- November 1999