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As the national movement for health care reform gives priority to activities that will achieve better and more efficient delivery of health care services, the cost-effectiveness of services will need to be calculated in some type of standard fashion. Although the cost-effectiveness of preventing and controlling acute diseases (for example, through mass immunization programs) has been well appreciated, less attention has been paid to the chronic diseases, which, in fact, account for the majority of illness and death in the United States today. This paper uses prevention of a common chronic disease, stroke, as a model to illustrate how cost savings measures may be developed and used to guide public policy.

The current burden of cardiovascular disease in the U.S. population and recent trends in morbidity, mortality and risk factors provide a perspective on heart disease in the 21st century. Projections of demographic trends for populations and predictions of the frequency, distribution and characteristics of cardiovascular disease in the future are offered with numerous reservations and subject to revision. Nonetheless, we can expect to see more patients with cardiovascular disease in the next few decades and these patients are likely to be older and to be from the less well-educated and poorer socioeconomic segments of society. Improvements in treatment for the initial cardiovascular event may result in increased survival of women and men suffering permanent damage or disability. There will also be better opportunities to prevent cardiovascular diseases through modifying risk factors in the general population and in high risk individuals. Non-invasive procedures will also increase opportunities for detecting and reversing preclinical atherosclerosis through hygienic and therapeutic measures.