title: Optimising health care within given budgets: primary prevention of cardiovascular disease in different regions of Sweden.
abstract: This study investigated the consequences of applying strict health maximisation to the choice between three different interventions with a defined budget. We analysed three interventions of preventing cardiovascular diseases, through doctor's advice on smoking secession, through blood-pressure-lowering drugs, and through lipid-lowering drugs. A state transition model has been used to estimate the cost-utility ratios for entire population in three different county councils in Sweden, where the populations were stratified into mutually excluding risk groups. The incremental cost-utility ratios are being presented in a league table and combined with the local resources and the local epidemiological data as a proxy for need for treatment. All interventions with an incremental cost-utility ratio exceeding the threshold ratios are excluded from being funded. The threshold varied between 1687 Euro and 6192 Euro. The general reallocation of resources between the three interventions was a 60% reduction of blood-pressure-lowering drugs with redistribution of resources to advice on smoking secession and to lipid-lowering drugs. One advantage of this method is that the results are very concrete. Recommendations can thereby be more precise which hopefully will create a public debate between decision-makers, practising physicians and patient groups.
authors: Department of Public Health and Clinical Medicine, Umeå University Centre for Epidemiology, National Board of Health and Welfare, SE-106 30, Stockholm, Sweden. emil.lofroth@sos.se
authors: Emil
authors: E
authors: Löfroth
authors: Lars
authors: L
authors: Lindholm
authors: Lars
authors: L
authors: Wilhelmsen
authors: Måns
authors: M
authors: Rosén
mesh_terms: D000328:Adult; D000368:Aged; D002017:Budgets; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D017598:Efficiency, Organizational / Q000191:economics*; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D013548:Sweden