Nutrition and Coronary Heart Disease
established, deaths due to all causes needs further investigation to explore the full effect
of these drugs.
With reference to hypertension, Crowley, Dunt and Day (1995) reported that the
majority of the health economics literature focused on the evaluation of alternative drug
regimes. They referred to studies by Johannesson and Farerberg (1992) and
Johannesson et al (1991), which compared the cost-effectiveness of both drug and non-
drug (dietary sodium restrictions and weight loss). These studies showed evidence that
the non-drug interventions had a less favourable cost benefit ratio than did drug
treatment. However, this could be due to the low compliance rate for the dietary
modifications.
Crowley, Dunt and Day (1995) also reviewed the economic literature for smoking
cessation interventions and reported on the preventive interventions for CHD aimed at
increasing physical activity. However, they concluded that there has been little focus on
evaluating the economic costs and benefits of such preventive interventions.
They reported that a study by Roberts et al (1987) found that if 50% of the adult
Australian population could be encouraged to participate in regular exercise, net
benefits would be returned. However, this study did not use rigorous economic
methods and used poor epidemiological evidence.
Crowley, Dunt and Day (1995) discussed the findings OfHatziandreu et al (1988) who
modelled the effects of regular exercise as a means Ofpreventing CHD. Although the
cohorts were hypothetical, it was found that the cost utility ratio for such an intervention
was in the order of US$11,313 (1985) per QALY. This is a favourable ratio when
compared with other medical and preventive interventions. However, more empirical
evidence needs to be gathered to confirm these results.
Despite the issues surrounding the comparison of the different methodologies discussed
above, Crowley, Dunt and Day (1995) concluded there is no evidence to suggest that
health promotion and secondary prevention interventions are necessarily more cost
effective than high technology surgical and drug treatments. There is evidence to
suggest that mass media education programs aimed at a single or multiple risk factor
produce favourable cost effective ratios in the prevention of CHD and CHD deaths.
CHERE Project Report 11 - November 1999
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