PubMedDate not supplied
Extensive public health programs are often proposed without a full appreciation of their effects on the target population. There is often a problem of confusing medical care that may be of benefit to an individual with care that may be of benefit to a population: care that may be highly beneficial for a selected patient may be substantially less effective for an unselected population. Exposing a large, asymptomatic population to diagnostic screening for coronary artery disease has cost and risk ramifications far beyond those of discovering people who might benefit from treatment of previously unsuspected disease. A program to screen 20 million people, and treat the most severely affected with coronary artery bypass graft, would cost nearly +9.2 billion. About +21,000 is spent to find each person with disease, while the cost is more than +169,000 for each person surviving surgical therapy. The cost per year of life extended is over +43,000. In excess of 8,000 persons have major complications and nearly 2,000 die from diagnostic testing and therapy. About half of major complications and deaths occur in persons without disease. This model integrating epidemiologic, economic, and decision analytic methods is presented to illustrate the potential use of myriad techniques in addressing population-based medical care and policy options; it does not provide the definitive answer, however, to the complex problem.