Skip to main content

Advertisement

SpringerLink
Log in

Nichtmedikamentöse Sekundärprävention der koronaren Herzkrankheit

Gesundheitsökonomische Aspekte

Non-pharmacological secondary prevention of coronary heart disease

Health economic aspects

  • Gesundheitspolitik
  • Published:
Prävention und Gesundheitsförderung Aims and scope Submit manuscript

Zusammenfassung

Ziel der Studie

Sowohl die Diagnosezahlen als auch die Kostengrößen verdeutlichen die hohe gesundheitsökonomische Relevanz der koronaren Herzkrankheit. Ziel der vorliegenden Studie ist es, die Kosteneffektivität nichtmedikamentöser sekundärpräventiver Maßnahmen nach Krankheitsauftritt zu bewerten. Hierzu zählen multimodale Programme wie auch Einzelinterventionen in Form von Raucherentwöhnung, psychosozialen Interventionen, körperlichem Training und Ernährungsumstellung.

Methodik

In 36 elektronischen Datenbanken wurde eine systematische Literaturrecherche vom Deutschen Institut für Medizinische Dokumentation und Information (DIMDI) durchgeführt. Zwei unabhängige Gutachter bewerteten die identifizierten Studien auf ihre Relevanz und Güte anhand standardisierter Kriterien.

Ergebnisse

Insgesamt wurden 3789 Referenzen ermittelt, von denen 19 Studien in die Bewertung eingingen.

Schlussfolgerungen

Während die Kosteneffektivität der multimodalen Programme häufig untersucht und bestätigt wurde fehlt es im Bereich der Einzelinterventionen an entsprechenden Untersuchungen. Hier besteht ein hoher Forschungsbedarf.

Abstract

Aim

Both the diagnosis statistics and costs illustrate the health economic relevance of coronary heart diseases. The aim of this study is to assess the cost-effectiveness of non-pharmacological secondary prevention strategies. These include multimodal prevention programmes as well as single component interventions in the form of smoking cessation, psychosocial interventions, physical exercise and diet modification.

Methods

A literature search was conducted by the German Institute for Medical Documentation and Information (DIMDI) in 36 electronic databases. Two independent reviewers assessed the identified studies for their relevance and quality using standardized criteria.

Results

A total of 3,789 references were identified, of which 19 studies were considered in the assessment.

Conclusions

While the cost-effectiveness of multimodal programmes has often been investigated and confirmed, there is a lack of appropriate studies evaluating single component interventions. Here, further research is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Annemans L, Lamotte M, Clarys P, Van den Abeele E (2007) Health economic evaluation of controlled and maintained physical exercise in the prevention of cardiovascular and other prosperity diseases. Eur J Cardiovasc Prev Rehabil 14:815–824

    Article  PubMed  Google Scholar 

  2. Ballegaard S, Borg E, Karpatschof B et al (2004) Long-term effects of integrated rehabilitation in patients with advanced angina pectoris: a nonrandomized comparative study. J Altern Complement Med 10:777–783

    PubMed  Google Scholar 

  3. Blitzer E, Busse R, Dörning H et al (1998) Bestandsaufnahme, Bewertung und Vorbereitung der Implementation einer Datensammlung „Evaluation medizinischer Verfahren und Technologien“ in der Bundesrepublik. Nomos, Baden-Baden

  4. Briffa TG, Eckermann SD, Griffiths AD et al (2005) Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial. Med J Aust 183:450–455

    PubMed  Google Scholar 

  5. Brown A, Taylor R, Noorani H et al (2003) Exercise-based cardiac rehabilitation programs for coronary artery disease: a systematic clinical and economic review. Canadian Coordinating Office for Health Technol Assess 71

  6. Cooper A, Skinner J, Nherera L et al (2007) Clinical guidelines and evidence reviews for post myocardial infarction: secondary prevention in primary and secondary care for patients following a myocardial infarction. National Collaborating Centre for Primary Care and Royal College of General Practitioners, London

  7. Dalziel K, Segal L, Lorgeril M de (2006) A mediterranean diet is cost-effective in patients with previous myocardial infarction. J Nutr 136:1879–1885

    PubMed  CAS  Google Scholar 

  8. Graf C, Halle M (2007) Die Bedeutung von körperlicher Aktivität bei koronarer Herzkrankheit. Dtsch Z Sportmed 58:322–327

    Google Scholar 

  9. Hambrecht R, Walther C, Mobius-Winkler S et al (2004) Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 109:1371–1378

    Article  PubMed  Google Scholar 

  10. Jolliffe JA, Rees K, Taylor RS et al (2000) Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 4:CD001800

    PubMed  Google Scholar 

  11. Jolly K, Taylor R, Lip GY et al (2007) The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technol Assess 11:1–118

    PubMed  CAS  Google Scholar 

  12. Karoff M (1998) Herz-Kreislauf-Erkrankungen am Beispiel der koronaren Herzkrankheit und des akuten Myokardinfarktes. In: Schwartz FW, Badura B, Leidl R et al (Hrsg) Das Public Health Buch. Gesundheit und Gesundheitswesen. Urban & Fischer, München Wien Baltimore, S 430–440

  13. Kolenda KD (2005) Sekundärprävention der koronaren Herzkrankheit: Effizienz nachweisbar. Dtsch Arztebl 26:1889–1895

    Google Scholar 

  14. Kotseva K, Wood D, De BG et al (2009) Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 373:929–940

    Article  PubMed  Google Scholar 

  15. Marchionni N, Fattirolli F, Fumagalli S et al (2003) Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation 107:2201–2206

    Article  PubMed  Google Scholar 

  16. Müller-Riemenschneider F, Damm K, Meinhand C et al (2009) Nichtmedikamentöse Sekundärprävention der koronaren Herzkrankheit (KHK). GMS Health Technol Assess 5

  17. Müller-Riemenschneider F, Meinhard C, Damm K et al (2010) Effectiveness of nonpharmacological secondary prevention of coronary heart disease. Eur J Cardiovasc Prev Rehabil 17:688–700

    Article  PubMed  Google Scholar 

  18. Papadakis S, Oldridge NB, Coyle D et al (2005) Economic evaluation of cardiac rehabilitation: a systematic review. Eur J Cardiovasc Prev Rehabil 12:513–520

    Article  PubMed  Google Scholar 

  19. Papadakis S, Reid RD, Coyle D et al (2008) Cost-effectiveness of cardiac rehabilitation program delivery models in patients at varying cardiac risk, reason for referral, and sex. J Cardiovasc Prev Rehabil 15:347–353

    Article  Google Scholar 

  20. Pavlovich WD, Waters H, Weller W, Bass EB (2004) Systematic review of literature on the cost-effectiveness of nutrition services. J Am Diet Assoc 104: 226–232

    Article  PubMed  Google Scholar 

  21. Quist-Paulsen P, Lydersen S, Bakke PS, Gallefoss F (2006) Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease. Eur J Cardiovasc Prev Rehabil 13:274–280

    Article  PubMed  Google Scholar 

  22. Raftery JP, Yao GL, Murchie P et al (2005) Cost effectiveness of nurse led secondary prevention clinics for coronary heart disease in primary care: follow up of a randomised controlled trial. BMJ 330:707–710

    Article  PubMed  Google Scholar 

  23. Salvetti XM, Oliveira JA, Servantes DM, Vincenzo de Paola AA (2008) How much do the benefits cost? Effects of a home-based training programme on cardiovascular fitness, quality of life, programme cost and adherence for patients with coronary disease. Clin Rehabil 22:987–996

    Article  PubMed  Google Scholar 

  24. Sandstrom L, Stahle A (2005) Rehabilitation of elderly with coronary heart disease – improvement in quality of life at a low cost. Adv Physiother 7:60–66

    Article  Google Scholar 

  25. Taylor R, Watt A, Dalal H et al (2007) Home-based cardiac rehabilitation versus hospital-based rehabilitation: A cost effectiveness analysis. Int J Cardiol 119:196–201

    Article  PubMed  CAS  Google Scholar 

  26. Yu CM, Lau CP, Chau J et al (2004) A short course of cardiac rehabilitation program is highly cost effective in improving long-term quality of life in patients with recent myocardial infarction or percutaneous coronary intervention. Arch Phys Med Rehabil 85:1915–1922

    Article  PubMed  Google Scholar 

  27. Zeidler J, Mittendorf T, Vahldiek G, Schulenburg JMGvd (2008) Kostenvergleichsanalyse der ambulanten und stationären kardiologischen Rehabilitation. Herz 33:440–447

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Versicherungsbetriebslehre, Forschungsstelle für Gesundheitsökonomie, Universität Hannover, Königsworther Platz 1, 30167, Hannover, Deutschland

    K. Damm Dipl.-Ök. & C. Vauth

  2. Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    F. Müller-Riemenschneider & S.N. Willich

  3. Arbeitsgruppe Gesundheitsökonomie und Gesundheitsmanagement, Universität Bielefeld, Bielefeld, Deutschland

    W. Greiner

Authors
  1. K. Damm Dipl.-Ök.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Müller-Riemenschneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Vauth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S.N. Willich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Greiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Damm Dipl.-Ök..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Damm, K., Müller-Riemenschneider, F., Vauth, C. et al. Nichtmedikamentöse Sekundärprävention der koronaren Herzkrankheit. Praev Gesundheitsf 6, 255–261 (2011). https://doi.org/10.1007/s11553-010-0287-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11553-010-0287-5

Schlüsselwörter

Keywords

Search

Navigation