Table 3.

Use of simulation model to show how coronary heart disease (CHD) outcomes are likely to change after implementation of service targets specified in the national service framework: treatment model^*

			Deaths from all causes
Results of simulation†	No of CHD patients	Life years saved	No of deaths	No prevented	Cost per life year saved
Baseline	30 843	—	2302	—
After intervention (20 iterations of model over 20 years)	32 603‡	1759	2109	193	£4998

^*Combined target levels of intervention (with no assumptions about any interaction between them): Revascularisation capacity increased to 3120 angiograms per million population and 1500 angioplasties and bypass grafts combined per million population; Secondary prevention drugs (aspirin, statins, ACE inhibitors, β blockers) provided to 90% of patients, allowing for contraindications; Cardiac rehabilitation offered to 85% of patients having bypass surgery, angioplasty, or myocardial infarction; Ambulance response times reduced to 75% within 8 minutes for myocardial infarction and cardiac arrest calls; Thrombolysis door-to-needle time reduced to 30 minutes for 75th centile of distribution for patients eligible for thrombolysis (excluding 10% who fail to receive thrombolysis at all).

^†Events per year in a population of 1 million.

^‡Increase in CHD patients is due to the reduction in case fatality.