BMJ 2002;325:197 ( 27 July )

Primary care

Resource implications and health benefits of primary prevention strategies for cardiovascular disease in people aged 30 to 74: mathematical modelling study

Tom Marshall, lecturer,  Andrew Rouse, senior lecturer. 

Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT

Correspondence to: T Marshall T.P.Marshall{at}bham.ac.uk

Objective: To develop a model to determine resource costs and health benefits of implementing guidelines for the prevention of cardiovascular disease in primary care.
Design: Modelling of data from six strategies for prevention of cardiovascular disease. Strategies incorporated two ways of identifying patients for assessment: traditional (assessment of all adults) and novel (preselection of patients for assessment using a prior estimate of their risk of cardiovascular disease). Three treatment strategies were modelled in conjunction with each identification strategy.
Setting: England.
Subjects: Patients aged 30 to 74 eligible for primary prevention strategies for cardiovascular disease who were selected from a hypothetical population of 2000.
Main outcome measures: Resource costs of assessing eligible adults, providing treatment and follow up to those eligible, and number of cardiovascular events this should prevent.
Results: Novel strategies prevented more cardiovascular disease, at lower cost, than traditional strategies. Some treatment strategies prevent more cardiovascular disease with fewer resources than others. The findings were robust across a range of different assumptions about workload.
Conclusion: Preselecting patients for assessment makes better use of staff time than assessing all adults. Treating many patients with low cost drugs is more efficient than prescribing a few patients intensive antihypertensives and statins. Authors of guidelines should model workload implications and health benefits of following their recommendations.

What is already known on this topic It is possible to estimate patients' risk of cardiovascular disease and their probability of benefiting from treatment There are data on the distribution of cardiovascular risk factors in the population What this study adds A model estimated the efficiency of six strategies for primary prevention of cardiovascular disease: three strategies followed guidelines and three prioritised patients for assessment on the basis of a prior estimate of cardiovascular risk Strategies that prioritise patients for risk assessment may reduce staff time to the extent that more patients can be treated and more disease prevented within available resources Statins and angiotensin converting enzyme inhibitors cost more than identifying and treating new patients, so strategies avoiding these may allow more disease to be prevented within available resources

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Rapid Responses:

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