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Allocation of resources between smoking cessation methods and lovastatin treatment of hypercholesterolaemia

Based on cost effectiveness and the social welfare function

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Abstract

Objective: To use the social welfare function to decide on allocation of resources between smoking cessation methods and lovastatin treatment of hypercholesterolaemia for the primary prevention of coronary heart disease.

Method: Three smoking cessation therapies (medical advice, nicotine gum and nicotine patch) were considered in smokers, and lovastatin 20, 40 and 80 mg/day was considered in individuals with hypercholesterolaemia (total cholesterol >7.24 mmol/L [>270 mg/dL]). Multiple logistic regression analysis was used to obtain parameter ε determining the exact form of the social welfare function in Catalonia, Spain. The preferable strategy was to give higher priority to the intervention that used one smoking cessation method and lovastatin treatment for hypercholesterolaemia and that was associated with a value of ε consistent with the social welfare function.

Results: A value of 1.58 (95% CI: 0.75–2.84) was obtained for parameter ε of the social welfare function, showing a nonutilitarian form. A higher priority should be given, based on the social welfare function, to the intervention using medical advice for smoking cessation and lovastatin 20–80 mg/day for hypercholesterolaemia, since this approach was associated with ε values of 2.8–2.9 in men and 1.8–2.4 in women, while interventions using nicotine substitution therapies were associated with ε values of <0.9 in men and <0.4 in women. The cost of treating all smokers and individuals with hypercholesterolaemia was 35% lower using medical advice for smoking cessation and lovastatin 20 mg/day, which was associated with ε values of 2.9 in men and 2.4 in women, than using a utilitarian solution consisting of nicotine patches for smoking cessation and lovastatin 20 mg/day.

Conclusion: These results show that higher priority should be given to lovastatin treatment of hypercholesterolaemia than to nicotine substitution treatments for smoking cessation, based on cost effectiveness and the social welfare function. The study also showed the applicability of this method to decisions about resource allocation between competing treatments when society has a nonutilitarian social welfare function.

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Acknowledgements

This study was developed without any financial support from any public or private institution.

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Authors and Affiliations

  1. Evaluation Unit, General Direction of Public Health, Travessera Corts 131–159, Barcelona, 08023, Spain

    Pedro Plans-Rubó

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  1. Pedro Plans-Rubó
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Appendix: The Questionnaire

Appendix: The Questionnaire

We ask you to choose between two societies, A and B, differing with respect to health gains in two population groups, defined as group 1 and group 2. These two groups are exactly alike for all other sociodemographic characteristics, including income level. We assume that health gains, measured in years, should be considered from age 50 years and that all individuals live each year of their lives in perfect health, except for the last 2 years when reduced quality of life (the same for both groups) occurs.

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Patient Questionnaire

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Both societies develop different health programmes due to differences in societal organisation and health resource management, which result in a different distribution of health gains between the two groups in the societies.

You shall choose between society A and society B knowing that you have a 50% probability of belonging to each group. Which society do you choose if health gains in group 1 and group 2, and average health gains in these societies, are distributed according to the questionnaire? Mark the society that you prefer.

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Plans-Rubó, P. Allocation of resources between smoking cessation methods and lovastatin treatment of hypercholesterolaemia. Pharmacoeconomic 22, 55–69 (2004). https://doi.org/10.2165/00019053-200422010-00005

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