Management of Pharmaceutical Resources for the Primary Prevention of Coronary Heart Disease in Catalonia (Spain) Based on Efficiency and Equity

The objective of the study was to develop a procedure to distribute health resources among treatments for the primary prevention of coronary heart disease based on efficiency and equity. Two procedures to manage pharmaceutical resources for the primary prevention of coronary heart disease in Catalonia, Spain, were developed in this study. The following treatments were considered in these procedures: medical advice and nicotine substitution therapies for smoking cessation; hydrochlorothiazide (diuretic) and propranolol (β-adrenergic antagonist) for moderate/severe hypertension; hydrochlorothiazide and nifedipine (calcium antagonist) for mild hypertension; and lovastatin (HMG-CoA reductase inhibitor) for hypercholesterolemia higher than 7.23 mmol/L or 2.7 g/L. The first procedure was developed based on decision rules of cost-effectiveness analysis, giving a higher priority to treatments with a higher cost effectiveness. The second procedure was developed based on efficiency and equity, deciding allocation of resources based on cost-effectiveness and social preferences. Annual cost of treatments ranged from $US147.30 per individual for smoking cessation to $US2555.20 per individual for treatment with lovastatin 80 mg/day (1998 values). Resources should be allocated in the following order, according to the procedure based on decision rules of cost-effectiveness analysis, to smoking cessation therapies, hypertension treatments and hypercholesterolemia treatments. This is in contrast to the procedure based on efficiency and equity, where a higher priority should be given to the most cost-effective treatment for hypertension, hypercholesterolemia and smoking. The efficiency and equity strategy could reduce the amount of resources necessary to treat all individuals at risk by 26 to 47%, according to age and gender. The procedure based on efficiency alone should be used when the objective is to maximize health gains from available resources. The procedure based on both efficiency and equity should be used when society has an aversion to inequality in the distribution of health gains, treating all individuals with coronary heart disease risk factors at the lowest cost.