Van Gool & Bridges
However, they concluded that:
"Before any firm conclusion can be made about the optimum mix of treatment and
prevention resources to the cardiovascular health of the Australian population, there is
a need for a systematic appraisal of the -wide range of interventions using Australian
costing data and epidemiological evidence from Australia and overseas ” (Crowley,
Dunt and Day, 1995).
Hall, Heller, Dobson, Lloyd, Sanson-Fisher, Leeder (1988)
The aim of the study conducted by Hall et al (1988) was to find the most cost-effective
intervention to reduce the incidence of CHD amongst men. The analysis examined
interventions targeted at different population groups.
The outcome measure used by Hall et al (1988) was events (i.e. heart attacks) avoided
on the basis that the focus of the analysis was reducing the incidence of CHD or acute
care utilisation rates.
Hall et al (1988) considered five alternative prevention strategies:
Intervention 1: A whole population approach -defined as involving a mass media
campaign in the first year, with a follow up campaign in the third year only.
Intervention 2: The identification of high-risk individuals - the screening of the whole
population to identify the top 15% of subjects at risk of CHD due to modifiable risk
factors. The intervention comprised of one standard consultation, a serum cholesterol
test, 2.5 long consultations and drug treatment for hypertensives in the first year. This
was followed up with one standard consultation in each subsequent year and ongoing
drug therapy for that period.
Intervention 3: A combined approach - advice on risk-factor modification was offered
to the total population in conjunction with a screening program for modifiable risk
factors as set out in Intervention Two. Intervention Three was considered as involving a
serum cholesterol test, 3.5 long consultations and drug treatment in the first year with
one standard treatment in each of the subsequent years.
Intervention 4: The identification of a group that was likely to be at high-risk - this
focused on using known epidemiological information on CHD to highlight sections of
the population who are at risk of CHD due to non-modifiable risk factors, age, socio-
economic status, and family history. It was assumed that this would be implemented
through the standard flow of visitations to GPs from the general population. GPs would
11 Chere Project Report 11- November 1999