Wellington Community Hospital

The cost-effectiveness of treating mild-to-moderate hypertension (diastolic blood pressures, 90-114 mmHg) was evaluated using the latest available information on both costs and benefits. The net health care costs of lifelong treatment for hypertension, at a 5% discount rate, ranged from 1491 pounds to 2752 pounds in men and from 1568 pounds to 2850 pounds in women in New Zealand in 1988 (1.00 pounds = $NZ 2.81). These figures take into account the savings in health care costs arising from stroke prevention. The net health care benefits, measured in quality-adjusted life years (QALYs) discounted at 5%, ranged from--2 days (a net negative effect of treatment) to 64 days in men and from--18 days to 35 days in women. The cost-effectiveness of antihypertensive therapy discounted at 5% (excluding categories of patients for whom the ratio was undefined due to a net negative effect of treatment on QALYs) ranged from 11,058 pounds to 63,760 pounds per QALY gained in men and from 22,060 pounds to 194,989 pounds per QALY gained in women. Treatment was more cost-effective in men than in women, in older age groups and at higher levels of pretreatment diastolic blood pressure. The cost-effectiveness ratios were highly sensitive to the discount rate used (with the majority of ratios in women being undefined at a 10% discount rate) and the costs of the regimen used (diuretic monotherapy being the most cost-effective, followed by beta-blockers, then angiotensin-converting enzyme inhibitors), as well as to the assumptions made about the impact of medication side effects on patient quality of life. These results call for a re-examination of resource allocation to antihypertensive treatment and point to the need to make assessments of the cost-effectiveness of alternative, non-pharmacological approaches to stroke prevention.

The risks and benefits of treating mild to moderate hypertension (defined as a diastolic blood pressure level between 90-114 mm Hg) were quantified in order to assist clinical decision making. Presenting such information ought to be an essential part of the process of obtaining the patient's consent for treatment. Using estimates from clinical trials that antihypertensive drug therapy reduces all-cause mortality by 11% and stroke incidence by 39%, the benefits of treatment--expressed as the average number of people needing to be treated annually in order to prevent one death--ranges from 333 to 3393 in men, and from 508 to 5094 in women. The average number of people needing to be treated annually to prevent one stroke ranges from 281 to 4292 in men, and from 253 to 13,477 in women. The benefits of treatment are greatest in men, in the older age groups, and at higher diastolic blood pressure levels. Compared to the benefits, the annual risk of developing a side effect of the medication is much higher.

SummaryThe comparative effects of alcoholism treatment programmes were examined by randomly assigning 113 male and female detoxified alcoholics to either: a 6‐week inpatient programme, a 6‐week outpatient programme or a single confrontational interview. On a variety of outcome measures, that included both levels of drinking and general functioning taken 6 and 18 months after intake, no treatment appeared to be consistently more effective than another. Furthermore, those who stayed in treatment did not show significantly more long‐term improvement than those who refused or dropped out of treatment.Abstinent subjects felt more often than drinkers that they had achieved the goals they had set themselves and by the final follow‐up there were many positive differences in apparent lifestyle.Although individual drinking patterns were unstable, on average, almost half the subjects located had either abstained or were drinking moderately. Patient and treatment variables combined explained up to 57% of the variance in amount drunk after treatment, with patient variables providing the strongest associations.

A New Zealand Cancer Registry based case-control study involved 617 male patients with prostate cancer registered during 1979 and aged 20 years or more at the time of registration. Controls were also males chosen from the Cancer Registry with two controls per case, matched on age and year of registration. There was an elevated risk in the upper social class groupings. The data did not support the findings, from other countries, of elevated risks in agricultural workers (odds ratio = 1.08, 90% confidence limits 0.86-1.36). The only occupational groups showing elevated risks were sales and service workers (odds ratio = 1.29, 90% confidence limits 0.99-1.69) and teachers (odds ratio = 2.44, 90% confidence limits 1.05-5.70). The New Zealand data do not in general suggest that occupational factors--or lifestyle factors associated with occupation--are of major direct importance in the aetiology of prostate cancer.