Skip Navigation


The European Journal of Public Health Advance Access originally published online on October 23, 2006
The European Journal of Public Health 2007 17(3):314-317; doi:10.1093/eurpub/ckl238
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
17/3/314    most recent
ckl238v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (1)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Essink-Bot, M.-L.
Right arrow Articles by Bonneux, L. G A
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Essink-Bot, M.-L.
Right arrow Articles by Bonneux, L. G A
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Miscellaneous

Evidence-based guidelines, time-based health outcomes, and the Matthew effect

Marie-Louise Essink-Bot1, Michelle E Kruijshaar1, Jan J Barendregt1,2 and Luc G A Bonneux1

1 Department of Public Health, Erasmus MC/University Medical Center Rotterdam The Netherlands
2 School of Population Health, University of Queensland Australia

Correspondence: M L Essink-Bot, MD PhD, Department of Public Health, Erasmus MC/University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands, tel: +31 10 408 7410; fax: +31 10 4638475; e-mail: M.ESSINK-BOT{at}ERASMUSMC.NL

Received May 25, 2006 , accepted August 29, 2006

Background: Cardiovascular risk management guidelines are ‘risk based’; health economists' practice is ‘time based’. The ‘medical’ risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model maximises numbers of life years gained by treating the young and non-smokers, or ‘the one who has will be given more’ (Matthew 25:29). We explored practical consequences of risk- or time-based allocation. Methods: We used epidemiological modelling to generate semi-quantitative scenarios comparing the distributional effects of allocating a fixed number of prescriptions of a (hypothetical) preventive cardiovascular drug (‘CVStop’) either to avert the maximum number of deaths (risk-based) or to save the maximum number of life years (time based) in the male Dutch population. We subsequently asked 123 Dutch guideline developers which distribution they preferred. Results: Time- and risk-based allocations resulted in different distributions of the drug across the population. There were also differences in absolute numbers of life years gained and deaths averted, and in the distribution of these across the population. For example, risk-based allocation of ‘CVStop’ resulted in preferential treatment of elderly, leading to more deaths averted (mostly among 70 and above) but fewer life years gained, if compared with time-based allocation. The guideline developers experienced the choice dilemmas as difficult. No priority choice was dominant among the respondents. Conclusion: In evidence-based resource allocation the choice to save time or to avert deaths may introduce moral choices because of the various origins of increased disease risk. Evidence-based guideline development inevitably has moral implications.

Keywords: absolute risk, cardiovascular disease, ethics, evidence-based medicine, life years gained, practice guidelines, resource allocation


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 BMJHome page
L. Bonneux
Cardiovascular risk models
BMJ, July 21, 2007; 335(7611): 107 - 108.
[Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.