[Cost-effectiveness analysis of cardiovascular disease prevention: a graded list as aid to the rational distribution of resources]. / Analys av kostnadseffektiviteten vid prevention av hjärt-kärlsjukdom: rankinglista ett hjälpmedel för att rätt fördela resurserna.

In a study designed to compare the cost-effectiveness of three cardiovascular disease prevention programmes, subject to a defined budget, a population was subgrouped according to risk levels. Cost per year of life saved and annual budget expenditure were calculated for each subgroup. Budget expenditure was defined in terms of current direct costs. A ranked list was constructed, and the cut-off level of 'acceptable' cost-effectiveness elicited.

Cost-effectiveness analysis with defined budget: how to distribute resources for the prevention of cardiovascular disease?

The aim of the study was to undertake cost-effectiveness calculations subject to a defined budget. The setting chosen was the prevention of cardiovascular disease (CVD) by means of three intervention programmes in a Swedish county council. The population in the county was divided into subgroups according to risk level. For each subgroup the cost per years of life saved was calculated, as well as the annual budget claims. The budget available was defined as present direct cost in the programmes. The calculations resulted in a programming solution showing the optimal distribution of resources between the programmes. Also a league table was constructed and the cut-off value for a 'acceptable' cost-effectiveness was shown. The conclusion that can be drawn is that a combination of internationally published intervention results and local data regarding epidemiology and resource improves the accuracy and usefulness of cost-effectiveness ratios. However, the model presented is a first attempt containing only three interventions: the planned next phase is to integrate more interventions in the model.

Management of digitalis therapy in a primary care area.

A retrospective study of 323 patients on digitalis therapy was performed in the primary care area of Skellefteå health district with the highest prescription of cardiac glycosides. The study comprised 90% of all patients on digitalis. Indications for treatment and the underlying heart disease were especially scrutinized. In one-third of all patients no underlying heart disease was defined and in about half of them the effectiveness of treatment was poorly documented. The study underlines the importance of defining the indication for treatment combined with a subsequent careful evaluation of the therapy in order to optimize treatment with cardiac glycosides.

What do patients know about their digitalis? A comparison between two different areas in Sweden.

Out of 1183 unselected out-patients in Skellefteå and 620 in Uppsala, 200 patients from each place were selected at random to be sent a questionnaire on their medication with digitalis. Answers to the questionnaires were obtained from 196 patients (98 per cent) in Skellefteå and from 163 patients in Uppsala (82 per cent). About 85 per cent stated that they took their digoxin as prescribed once a day. About 60 per cent knew correctly why digoxin treatment was given and 20 per cent were uncertain as to why they took digoxin. About 45 per cent stated that they felt improved thanks to the digoxin therapy. 55 per cent did not know about digitalis side-effects. About 50 per cent denied having received any information about digitalis and 50 per cent were unsatisfied with the information they had been given. Only 15 per cent were content with the information. Methods for improving the information to patients are proposed.