Van Gool & Bridges
The setting for this intervention is in hospital and includes outpatient clinics. For the
purpose of costing it was assumed that dietitians run the clinics with the assistance of
some administrative staff.
Some Key Issues for Each Intervention
GPBased Intervention
The cost per life saved in a screening program remains relatively high. Screening is a
costly procedure if it is executed on a large scale (Hall et al. 1988). Also, screening
does not necessarily prevent CHD, it merely identifies those who have an elevated risk
of CHD. There are a number of other steps, for example, behaviour modification,
before one CHD death is prevented.
It is important to note that as relatively few people will fall into the “high-risk category”
(compared to the general population) most CHD events will originate from the group
with only moderately raised levels of the risk factor. In other words, due to the relative
large size of the general population group compared to the number of “high-risk”
individuals, more CHD deaths are going to occur in the general population (Mant 1996).
The Community Intervention
This high-risk group approach, also examined by Hall et al (1988), has intuitive appeal,
but the evidence for its effectiveness remains limited. However, results from a number
of recent papers, together with some assumptions, allow an estimation of an
effectiveness measure to be made (see for example Brown et al 1996, Ammerman et al
1992, Lee et al 1994).
There is a large volume of work that allows the identification of high-risk groups. For
example, males and females in the lowest SES quintile have a 54% and 124% relatively
greater risk of developing CHD than their highest SES counterparts. Indigenous people
also have an increased risk of developing CHD up to three times that of non-indigenous
people. Also, some migrant groups have higher risks. People bom in New Zealand,
Fiji, Malta, India, Lebanon and Poland have higher CHD mortality rates than the rest of
NSW (Mathers 1994, NSW Health Dec 1997, National Health Strategy 1992).
19
Chere Project Report 11- November 1999