Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-24T18:21:39.484Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost effectiveness of cardiovascular disease prevention strategies: a perspective on EU food based dietary guidelines

Published online by Cambridge University Press:  01 April 2001

Eric Brunner ,
David Cohen  and
Lynn Toon
Eric Brunner*
Affiliation:
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 1–19 Torrington Place, London WC1 E 6BT, UK
David Cohen
Affiliation:
Business School, University of Glamorgan, Pontypridd, CF37 1DL, UK
Lynn Toon
Affiliation:
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 1–19 Torrington Place, London WC1 E 6BT, UK
*
*Corresponding author: Email e.brunner@ucl.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

For policymakers considering strategy options for the prevention of cardiovascular disease (CVD) the distinction between effectiveness and cost effectiveness is critical. When cost limitations apply, an evaluation of cost effectiveness is essential if a rational decision is to be made. Policy changes and resource reallocation have opportunity costs, and therefore it is necessary to compare the cost of health gains achievable by means of different policies. Here the broad question is: How cost effective are diet change strategies compared to other measures aimed at reducing cardiovascular disease in EU member states?

An overview of published studies of cost effectiveness in the primary and secondary prevention of cardiovascular disease was conducted. Few comprehensive studies were available.

Estimated costs per life year gained were as follows: population-based healthy eating £14–560; smoking cessation £300–790; nurse screening and life style advice £900 (minimum); simvastatin (HMGCoA reductase inhibitor) £6200–11 300. Cost effectiveness is dependent on the underlying level of CVD risk in the target population, and the duration of the achieved alterations in behaviours and risk factors.

The limited evidence from these studies tends to support the view that health protection strategies which promote healthy eating are likely to be more cost-effective than strategies involving modern cholesterol-lowering drugs, screening and advice in primary care, and are comparable to or less expensive per year of life saved than anti-smoking strategies. Given the considerable diversity in food habits, health care and public health systems among current and prospective EU member states, careful appraisal of the policy options within each member state is desirable to ensure that health gain is maximised. EU wide food based dietary guidelines are potentially the basis of large health gains in Europe, and cost-effectiveness studies tend to support their adoption.

Keywords

Cardiovascular diseaseHealth promotionLifestyleDietSmoking cessationSimvastatinHealth economy
Type
Research Article
Information
Public Health Nutrition , Volume 4 , Issue 2b , April 2001 , pp. 711 - 715
Copyright
Copyright © CABI Publishing 2001

References

1Brunner, EJ, White, IR, Thorogood, M, Bristow, A, Curle, D, Marmot, MG. Can dietary interventions change diet and cardiovascular risk factors? A meta-analysis of randomized controlled trials. Am. J. Public Health 1997; 87: 1415–22.CrossRefGoogle ScholarPubMed
2Nissinen, A, Tuomilehto, J, Kottke, TE, Puska, P. Costeffectiveness of the North Karelia Hypertension Program. 1972–1977. Medical Care 1986; 24: 767–80.Google Scholar
3Sculpher, MJ, Petticrew, M, Kelland, JL, Elliott, RA, Holdright, DR, Buxton, MJ. Resource allocation for chronic stable angina: a systematic review of effectiveness, costs and costeffectiveness of alternative interventions. Health Technol. Assessment 1998; 2(10): i–iv, 1–176.Google Scholar
4Wonderling, D, Langham, S, Buxton, M, Normand, C, McDermott, C. What can be concluded from the Oxcheck and British family heart studies: Commentary on cost effectiveness analyses. British Medical Journal 1996; 312: 1274–8.Google Scholar
5Ebrahim, S, Davey Smith, G, McCabe, C, Payne, N, Pickin, M, Sheldon, TA, et al. What role for statins? A review and economic model. Health Technol. Assessment 1999; 3(19): 1–91.Google Scholar
6Tosteson, AN, Weinstein, MC, Hunink, MG, Mittleman, MA, Williams, LW, Goldman, PA, Goldman, L. Cost-effectiveness of population-wide educational approaches to reduce cholesterol levels. Circulation 1997; 95: 24–30.Google Scholar
7Johannesson, M, Johansson, P. The discounting of lives saved in future generations – some empirical results. Health Economics 1996; 5: 329–32.Google Scholar
8Schmitt, A, Chambolle, M, Millstone, E, Brunner, EJ, Lobstein, T. Nutritional surveillance in Europe. ESTO/IPTS Report C-10-97, 1–73, 1998.Google Scholar
9Kristiansen, IS, Eggen, AE, Thelle, DS. Cost effectiveness of incremental programmes for lowering serum cholesterol concentration: is individual intervention worth while? British Medical Journal 1991; 302: 1119–22.CrossRefGoogle ScholarPubMed
10Baxter, T, Milner, P, Wilson, K, Leaf, M, Nicholl, J, Freeman, J, Cooper, N. A cost effective, community based heart health promotion project in England: prospective comparative study. British Medical Journal 1997; 315: 582–5.CrossRefGoogle ScholarPubMed
11Ratcliffe, J, Cairns, J, Platt, S. Cost effectiveness of a mass media-led anti-smoking campaign in Scotland. Tobacco Control 1997; 6: 104–10.Google Scholar
12Stapleton, JA, Lowin, A, Russell, MA. Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness. Lancet 1999; 354: 210–5.Google Scholar
13Dougenis, D, Naik, S, Brown, AH. Is repeated coronary surgery for recurrent angina cost effective? Eur. Heart J. 1992; 13: 9–14.CrossRefGoogle ScholarPubMed
14Edelson, JT, Weinstein, MC, Tosteson, AN, Williams, L, Lee, TH, Goldman, L. Long-term cost-effectiveness of various initial monotherapies for mild to moderate hypertension. JAMA 1990; 263: 407–13.Google Scholar