Cost-effectiveness of primary prevention of coronary heart disease through risk factor intervention in 60-year-old men from the county of Stockholm--a stochastic model of exercise and dietary advice

Prev Med. 2003 Apr;36(4):403-9. doi: 10.1016/s0091-7435(02)00060-9.


Background: Recent screenings show a high prevalence of cardiovascular risk factors in the county of Stockholm. Primary prevention may be a way to lower the risk burden of coronary heart disease, but we must establish that preventive programs are cost-effective.

Methods: Through the use of a stochastic Markov model, which predicts reduction in coronary heart disease events based on risk factor reductions, this study evaluates the results of a previous controlled trial in middle-aged men comparing dietary advice, exercise, and the combination of both applied to an observed cohort of 60-year-old men in the county of Stockholm.

Results: The model predicts lower costs and higher effectiveness for dietary advice compared to the alternatives. Assuming a declining effect of the intervention, dietary advice saves 0.0228 life-years compared to no intervention. If no decline is assumed, the corresponding figure is 0.0997 life-years. From the societal perspective, the added costs are 2,892 Swedish Kronor (SEK) and 14,106 SEK for the two modeling assumptions, resulting in a cost-effectiveness of 127,065 SEK per life-year gained (LYG) and 141,555 SEK/LYG. These figures are below what is generally thought of as cost-effective.

Conclusion: Based on the model, dietary advice appears to be the most cost-effective of the studied interventions.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Coronary Disease / prevention & control*
  • Cost-Benefit Analysis
  • Exercise*
  • Feeding Behavior*
  • Health Behavior*
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Education as Topic / economics
  • Patient Education as Topic / methods
  • Primary Prevention / economics*
  • Quality-Adjusted Life Years
  • Risk Factors
  • Stochastic Processes
  • Survival Analysis
  • Sweden