Quantifying the health benefits of chronic disease prevention: a fresh approach using cardiovascular disease as an example

Abstract

Current methods of determining the proportion of people who benefit from a preventive intervention and the years of life gained can underestimate the former and overestimate the latter. We describe how to overcome these errors, using two examples relating to the prevention of myocardial infarction (MI) and stroke, one using a specified polypill daily from age 50 and another reducing salt intake in the population. Standard life table analysis was used to calculate the person-years of life gained without an MI or stroke, based on estimates of the incidence of these disorders in England and Wales. The proportion of individuals who benefit was taken as everyone who would, without treatment, have an MI or stroke (holistic model), rather than limiting the benefit to the proportion calculated from the relative risk reduction (reductionist model), as is current practice. Under the holistic model, 33% of people who take the polypill from age 50 benefit, gaining, on average, 8 years of life without an MI or stroke (19% and 14 years under the reductionist model). Estimates for reducing salt intake by 6 g/day are 33% and 2.8 years respectively under the holistic model (6% and 16 years under the reductionist model). In the prevention of disorders such as stroke by reducing exposure to causal factors such as blood pressure, the use of a holistic model corrects the underestimation of the proportion of people who benefit and the overestimation of their years of life gained associated with current methods.

Fig. 1

Illustration of the effect of intercurrent death on the classification of benefit under the reductionist and holistic models (MI myocardial infarction)