Treatment and Controversies in Angina Pectoris: Economics of Prevention and Treatment

Abstract

We assume a prevalence of clinical coronary artery disease of 2·5%, that 50% of these patients have angina pectoris and have an assumed mean age of 50 or 60 years, that the annual mortality is 4%, that 50% smoke, that stopping smoking reduces mortality in the smokers by 50%, and that treatment (medical and/or surgical) reduces mortality by 25%. On the basis of these assumptions we calculate benefits in terms of life years gained. Primary prevention through stopping smoking will increase survival of the entire population by 12·5%. This is a substantial gain at no cost. Doctors should do more to achieve this goal. Treatment will add about 1·9 life years per 50-year-old patient treated and about 1·7 life years per 60-year-old patient treated. A gained life year costs less than $4000 in treatment expenses. We calculate that treatment is cost effective in terms of money for the 50-year-old patient who will return to work, but not for the 60-year-old patient. This conclusion must of course be carefully considered in the light of values other than money. Expansion of treatment to low-risk groups may lead to only marginal benefit and lead to less emphasis on prevention. The concept of opportunity cost is discussed using prevention of suicide as an example.