A cost-benefit analysis of a cardiovascular disease prevention trial, using folate supplementation as an example

J. Hornberger

American Journal of Public Health, 1998, vol. 88, issue 1, 61-67

Abstract: Objectives. This study illustrates a cost-benefit analysis of clinical trial design, using as an example a trial of folate supplementation to prevent cardiovascular disease. Methods. Bayesian statistical and decision- analytic techniques were used to estimate the cost-benefit and sample size of a placebo-controlled trial of folate targeted to US citizens, aged 35 to 84 years, with elevated serum homocysteine levels. The main end point is event- free survival (i.e., survival without new ischemic heart disease or stroke) at 5 years. Results. Because the screening cost and annual cost and inconvenience of taking folate is small compared with the consequences of stroke, ischemic heart disease, or death, the increase in 5-year event-free survival with folate that should compel the use of folate is just 1.1%. The sample size per group needed to establish this level of folate's medical effectiveness is estimated to be 17 310. Such a trial would provide an expected societal cost-benefit savings exceeding $11 billion within 15 years. Conclusions. This study illustrates how Bayesian methods may help in assessing the societal cost-benefit consequences of proposed disease prevention trials, deciding which trials are worth sponsoring, and designing cost-effective trials.

Date: 1998
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:1998:88:1:61-67_6

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