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

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  • Hornberger, J.

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.

Suggested Citation

  • Hornberger, J., 1998. "A cost-benefit analysis of a cardiovascular disease prevention trial, using folate supplementation as an example," American Journal of Public Health, American Public Health Association, vol. 88(1), pages 61-67.
    • Handle: RePEc:aph:ajpbhl:1998:88:1:61-67_6
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    Cited by:

    1. Fleurence, Rachael L. & Torgerson, David J., 2004. "Setting priorities for research," Health Policy, Elsevier, vol. 69(1), pages 1-10, July.
    2. Meltzer, David, 2001. "Addressing uncertainty in medical cost-effectiveness analysis: Implications of expected utility maximization for methods to perform sensitivity analysis and the use of cost-effectiveness analysis to s," Journal of Health Economics, Elsevier, vol. 20(1), pages 109-129, January.
    3. Fumie Yokota & Kimberly M. Thompson, 2004. "Value of Information Literature Analysis: A Review of Applications in Health Risk Management," Medical Decision Making, , vol. 24(3), pages 287-298, June.

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