Cost-Effectiveness of Prevention,Intervention,and Therapeutic Strategies in Coronary Artery Disease

Coronary artery disease continues as the nation's number one killer. The past decade's prevention efforts may be termed: the reduction of high blood pressure; the assault on smoking; the lifestyles of the thin and pretty; and now the coming years: the promise; the siege on cholesterol. Occurring simultaneously is an explosion of drugs, targeted for action against the reduction in levels of these factors; the extremely effective targeted drugs to reduce the effort or work with which the heart contends and even drugs designed to dissolve the very lesions that create coronary artery disease. Also, there has been parallel growth in the invasive procedures aimed at lessening the toll of this disease. This article reviews the epidemiology of coronary artery disease and its implications for cost-effectiveness analyses both in terms of the concept of prevention, the corollary, delay in the onset of coronary artery disease; the diminishing value of delay in relationship to the prevalence of the disease; the demographic consequences of the baby boom and the potential that fundamental changes in the horizon for our health care system can have on delivery of health care and cost-effectiveness analyses. While controversy will continue to take place over the discount rate and/or human capital approaches to indirect costs, the impact of rapid changes in technology, the epidemiology of disease, and the costs of delivery of care are shown to be of greater fundamental importance in the assessment of prevention v therapeutic approaches in coronary artery disease.