title: Cost-effectiveness perspectives in coronary heart disease.
abstract: In the United States there has been a dramatic decrease in age-adjusted coronary heart disease (CHD) mortality during the last 20 years. This article investigates the reasons for this decline and concludes that most of the decline in CHD has been the result of life-style changes, particularly reduction in serum cholesterol and cigarette smoking. The CHD Policy Model is used to compare the effect of a targeted versus a population-wide program of cholesterol reduction. On the basis of these projections, population-wide interventions are considered an important part of cholesterol reduction programs. The article also assesses the cost-effectiveness of selected cardiac interventions, for example, screening exercise tolerance tests, coronary care units, thrombolysis in acute myocardial infarction, and beta-blockers in patients after myocardial infarction. Cost-effectiveness analysis is seen to be crucial as medical costs escalate and the population at risk from CHD increases.
authors.affiliation: Consolidated Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: L
authors.initials: L
authors.lastname: Goldman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000191:economics; D003325:Coronary Care Units / Q000191:economics; D003327:Coronary Disease / Q000191:economics* / Q000401:mortality / Q000628:therapy; D003362:Cost-Benefit Analysis / Q000639:trends; D005080:Exercise Test / Q000191:economics; D005544:Forecasting; D006291:Health Policy; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000191:economics; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists