Kardiologie up2date 2008; 4(3): 201-205
DOI: 10.1055/s-2008-1077590
Hotline – Koronare Herzerkrankung und Atherosklerose

© Georg Thieme Verlag KG Stuttgart · New York

Kann man durch Prävention Geld einsparen?

Helmut  Gohlke
Further Information

Publication History

Publication Date:
29 October 2008 (online)

Abstract

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.

Literatur

  • 1 Russel L B, Gold M R, Siegel J R, Daniels N, Weinstein M C. The role of cost-effectiveness analysis in health and medicine.  JAMA. 1996;  276 1172-1177
  • 2 Johannesson M, Jönsson B, Kjekshus J, Olsson A G, Pedersen T R, Wedel H. Cost-effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease.  N Engl J Med. 1997;  336 332-336
  • 3 Lindgren P, Lindström J, Tuomilehto J. et al . DPS Study Group. Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective.  Int J Technol Assess Health Care. 2007;  23 177-183
  • 4 Lauterbach K W, Gerber A, Klever-Deichert G, Stollenwerk B. Kosteneffektivität der Prävention der koronaren Herzkrankheit in Deutschland.  Z Kardiol. 2005;  94 (Suppl 3) 100-104
  • 5 Chan P S, Nallamothu B K, Gurm H S, Hayward R A, Vijan S. Incremental Benefit and Cost-Effectiveness of High-Dose Statin Therapy in High-Risk Patients With Coronary Artery Disease.  Circulation. 2007;  115 2398-2409
  • 6 Deedwania P, Barter P, Carmena R. et al . Reduction of low-density lipoprotein cholesterol in patients with coronary heart disease and metabolic syndrome: Analysis of the Treating to New Targets study for the Treating to New Targets Investigators.  Lancet. 2006;  368 919-928
  • 7 National Institute for Health and Clinical Excellence .NICE guidance on the use of statins set to benefit millions of adults. 2006 http://www.nice.org.uk
  • 8 Gohlke H, Albus C, Bönner G. et al .Pocket-Leitlinien: Risikoadjustierte Prävention von Herz- und Kreislauferkrankungen. http://www.dgk.org 2007
  • 9 Johannesson M. At what coronary risk level is it cost-effective to initiate cholesterol lowering drug treatment in primary prevention?.  Eur Heart J. 2001;  22 919-925
  • 10 Greving J P, Buskens E, Koffijberg H, Algra A. Cost-Effectiveness of Aspirin Treatment in the Primary Prevention of Cardiovascular Disease Events in Subgroups Based on Age, Gender, and Varying Cardiovascular Risk.  Circulation. 2008;  117 2875-2883
  • 11 Ridker P M, Cook N R, Lee I M, Gordon D, Gaziano J M, Manson J E, Hennekens C H, Buring J E. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women.  N Engl J Med. 2005;  352 1293-1304

Professor Dr. med. Helmut Gohlke

Chefarzt Klinische Kardiologie II
Herz-Zentrum Bad Krozingen

Südring 15
79189 Bad Krozingen

Email: helmut.gohlke@herzzentrum.de

    >