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Evidence-based guidelines, time-based health outcomes, and the Matthew effect
Marie-Louise Essink-Bot1, Michelle E Kruijshaar, Jan J Barendregt
1Department of Public Health, Erasmus MC/University Medical Center, Rotterdam, The Netherlands. M.ESSINK-BOT@ERASMUSMC.NL
European Journal of Public Health
|October 25, 2006
Summary
Health economists face a dilemma: prioritize preventing deaths in high-risk individuals or maximizing life years gained in younger populations. Both approaches have different outcomes and moral implications in cardiovascular risk management.
Area of Science:
- Epidemiology
- Health Economics
- Medical Ethics
Background:
- Current cardiovascular risk management guidelines use a 'risk-based' approach, targeting high-risk individuals like the elderly and smokers to prevent deaths.
- Health economists often employ a 'time-based' allocation model, prioritizing younger, non-smoker populations to maximize life years gained.
- These differing allocation models present practical and ethical challenges in resource distribution for preventive cardiovascular drugs.
Purpose of the Study:
- To compare the distributional effects and outcomes of risk-based versus time-based allocation of a hypothetical cardiovascular drug (CVStop).
- To explore the practical consequences of these two distinct resource allocation strategies in cardiovascular risk management.
- To gauge the preferences of guideline developers when faced with the choice between averting deaths and saving life years.
Main Methods:
- Utilized epidemiological modeling to create semi-quantitative scenarios for drug allocation.
- Compared risk-based (maximum deaths averted) and time-based (maximum life years gained) allocation strategies.
- Surveyed 123 Dutch guideline developers on their preferred allocation distribution.
Main Results:
- Risk-based and time-based allocations yielded different population distributions of the drug.
- Risk-based allocation prioritized the elderly, averting more deaths but gaining fewer life years compared to time-based allocation.
- Guideline developers found the choice dilemmas difficult, with no single priority emerging as dominant.
Conclusions:
- The choice between saving life years or averting deaths in evidence-based resource allocation involves moral considerations due to varying disease risk origins.
- Evidence-based guideline development inherently incorporates moral implications, particularly in resource-constrained scenarios.
- The study highlights the complex ethical landscape of cardiovascular risk management and drug allocation.
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