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© Georg Thieme Verlag KG Stuttgart · New York
Kann man durch Prävention Geld einsparen?
29 October 2008 (online)
Cost-effectiveness is dependent on the global risk of the patient to be treated, the effectiveness of the treatment modality and the costs of the treatment. These baseline factors modify the number needed to treat (NNT) which should be determined to help in the decision for or against treatment. In all patients above 40 with more than one risk factor a risk stratification with one of the scoring systems should be done to identify persons in whom treatment of risk factors is clinically warranted and cost-effective.
Cost-effectiveness of prevention may be viewed from the perspective of the patient, the insurance company or the retirement fund and may be modified by age and gender. Indirect costs are largely modified by nonmedical factors like employment status, absence from work etc.
In Persons with a global 10 year risk of 20 % or higher and in patients with established atherosclerosis treatment with statins, ASS and intensive efforts for life style changes individually and together are likely to be cost-effective. In women however ASS is less effective in preventing myocardial infarction, therefore alternative ways of prevention should be considered. Also in patients with a prominent single risk factor and a global 10 year risk in the intermediate range (10 – 19 %) the NNT can be below 200 and treatment therefore costeffective. A 10-year global risk of > 20 % and/or a NNT of less than 200 make prevention worthwhile.
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Professor Dr. med. Helmut Gohlke
Chefarzt Klinische Kardiologie II
Herz-Zentrum Bad Krozingen
79189 Bad Krozingen
Email: [email protected]