The name is absent

Nutrition and Coronary Heart Disease

select those at high-risk and offer information on the modification of other risk factors
for CHD. Intervention 4 included the costs of increasing a short consultation to a long
one, 2.5 additional long consultations and treatment for hypertension in the first year.
Again a standard consultation and ongoing drug therapy would follow this in the
remaining four years.

Intervention 5: The identification of those who already have CHD - Hall et al (1988)
noted that those who already have symptoms of CHD are 3 to 4 times more likely to
suffer a myocardial infarction than other members of population. Intervention 5
involved the costs of an electrocardiograph, two long consultations and drug treatment
for hypertension in the first year, while there would be the costs of one standard
consultation and treatment in the subsequent years.

For the purposes of their analysis Hall et al (1988) focused on the costs and benefits of
the intervention for a period of five years only. In addition, they assumed that there
would be an equal success rate of the intervention in each year. In addition to the direct
costs and benefits, Hall et al (1988) estimated the indirect savings associated with lower
hospitalisation rates due to the lower incidence of CHD, but these were estimated for
the five-year time frame only.

Hall et al (1988) included the savings from the prevention of a coronary bypass surgery
in the analyses. However, this assumes that the surgery was prevented forever. If it
were only postponed from the fifth to the sixth year, then the net saving would only be
equal to the interest accumulated from holding onto the surgery costs for another year.
Furthermore, if one CHD death is prevented, there is a possibility that other health
burdens will be added to the health care system in future years. This would lead to an
overestimation of the benefits.

CHERE Project Report 11 - November 1999

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