Effectiveness of programmes as part of primary prevention demonstrated on the example of cardiovascular diseases and the metabolic syndrome
Copyright policy )Effectiveness of programmes as part of primary prevention demonstrated on the example of cardiovascular diseases and the metabolic syndrome
Background The HTA-report (HTA = Health Technology Assessment) deals with the primary prevention of cardiovascular diseases and diabetes mellitus type 2. In 2009 approximately 356,000 people died in Germany due to cardiovascular diseases. According to estimations about 6.3 million people are suffering from diabetes mellitus type 2. The interventions that are subsidized by the public health insurance are mainly focused on sufficient physical activities, healthy nutrition, stress management and the reduction of the consumption of addictive drugs and luxury food. Objectives Which lifestyle-related measures and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are effective? To what extent will the health status be improved by these offers? To what extent will existing health resources and skills be strengthened by these offers? Are there any differences regarding the effectiveness among the interventions with respect to different settings or subgroups? Which lifestyle-related interventions and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are sustainable and cost-effective? Which outcome parameters are in the view of the contributors decisive for the evaluation of the effectiveness? In the view of the contributor are there different values between the outcome parameters? In the view of the payers and other actors are there different values between the outcome parameters? Which ethical and juridical factors have to be considered? Which social and/or socio-economic parameters influence the use of the services and effectiveness? Methods A systematic literature research is done in 35 databases. For the period 2005 to 2010, reviews, epidemiological and clinical studies as well as economical evaluations which deal with primary prevention programmes regarding cardiovascular diseases or the metabolic syndrome are included. Results 44 publications meet the inclusion criteria. These studies confirm the effectiveness of the primary prevention programmes. Physical activity programs seem to have a stronger effect than nutrition programmes. Psychological programmes prove as well effectiveness, if they include cognitive behaviour therapy. The identified economical studies indicate that programmes for cardiovascular prevention can be conducted cost-effectively. Interventions that focus on the general population turn out to be particularly cost-effective and sustainable. Discussion There is a wide range of primary preventive effective lifestyle-related interventions with high evidence. The outcomes and results are consistent with the recommendations of the two identified evidence-based guidelines regarding the recommendations on lifestyle and healthy nutrition. Furthermore, the cost-effectiveness of primary prevention services is proven. With regard to the economical studies it is however worth noting that this result is based on very few publications. The transferability has to be critically assessed as the studies mainly originate from the American health system. Conclusion On the whole a comprehensive setting approach with educative, somatic, psychosocial and activity therapeutic components is recommended. The sustainability of a prevention intervention must be ensured from programme to programme. Long-term studies are necessary to make valid statements regarding the sustainable effectiveness: There is an essential deficit in the current practiced evaluation of the use of primary prevention services provided by the health insurance – mainly regarding the comprehensive setting approach – regarding the evidence-based evaluation of the prescribed preventive interventions. With regard to the ethical, social and economical evaluation the research situation is deficient. The situation has to be particularly analyzed for the socially deprived and one has to respond to their specific needs for prevention.
GMS Health Technology Assessment; 7:Doc02; ISSN 1861-8863
- GP Forschungsgruppe Germany
Stoffwechselstörung, TECHNOLOGY ASSESSMENT, BIOMEDICAL, CARDIOVASCULAR DISEASES, LIPIDSTOFFWECHSEL, Risikoabschätzung, Methodik, models, economic, Meta-Analyse, nutritional physiological phenomena, Blutglukose, randomisierte kontrollierte Studie, biomedical technology assessment, PEER REVIEW, RISK ASSESSMENT, ECONOMICS, MEDICAL, Effizienz, Pflege, humans, judgment, specifity, Präventionsprogramm, Lebensqualität, Übergewicht, Ökonomie, Übersichtsliteratur, HTA, review literature as topic, clinical trial, health policy, Rechte, BLUTGLUCOSE, Diagnose, prevention research, diabetes mellitus, technology, metabolisches Syndrom, Kostensenkung, cerebrovascular accident, randomisierte kontrollierte Studien, LEBENSQUALITÄT, SOZIALÖKONOMISCHE FAKTOREN, INSULIN RESISTANCE, HYPERTONIE, ZEREBROVASKULÄRER INSULT, kontrollierte klinische Studien, medical evaluation, DIABETES MELLITUS, Peer Review, randomisierte Zuordnung, CLINICAL TRIALS AS TOPIC, Metaanalyse, Article, methods, insult, multizentrische Studien, Zufall, Behandlung, Technikfolgen-Abschätzung, biomedizinische, health education, multicenter studies as topic, prospektive Studien, health technology assessment, validation studies, HERZKRANKHEITEN, Gesundheitsökonomie, Genauigkeitsstudie, LEBENSSTIL, MULTICENTER STUDIES AS TOPIC, life style, health economic studies, Fettstoffwechsel, Herzkrankheiten, randomized clinical trial, sensitivity, systematische Übersicht, cardiovascular diseases, HEART DISEASES, MULTIZENTRISCHE STUDIEN, Gesundheitsziele, META-ANALYSIS AS TOPIC, TECHNOLOGIE, quality of life, MODELS, ECONOMIC, randomized controlled trial, life qualities, REVIEW LITERATURE AS TOPIC, KONTROLLIERTE KLINISCHE STUDIEN, PRIMARY PREVENTION, GESUNDHEITSWESEN, Insulinresistenz, HEALTH PROMOTION, Lebensstil, meta analysis, Ernährung, PROGRAM EVALUATION, evidence based medicine, health care sector, costs, HEALTH EDUCATION, Apoplexie, Gesundheitsaktion, PLACEBOS, sozioökonomische Faktoren, randomised clinical trial, METABOLISCHES SYNDROM X, Fettleibigkeit, gesundheitsökonomische Studien, PREVENTIVE MEDICINE, Methoden, VERHALTENSTHERAPIE, Zuckerkrankheit, Hypertonie, health economics, sozialökonomische Faktoren, preventive care, LIPID METABOLISM, kardiovaskuläre Erkrankungen, Lebensqualitäten, adiposity, EbM, cost effectiveness, HEALTH POLICY, HEALTH CARE SECTOR, Lipidstoffwechsel, COSTS AND COST ANALYSIS, Rehabilitation, Beurteilung, Verblindung, health, RANDOMISIERUNG, Sensitivität, RANDOM ALLOCATION, research article, controlled clinical trials as topic, Kosten und Kostenanalyse, Kosten-Nutzen-Analyse, technology evaluation, ADIPOSITY, JUDGMENT, GESUNDHEITSPOLITIK, movement, evidence-based medicine, Herzkrankheit, randomisierter Versuch, CT, sozio-ökonomische Faktoren, EFFICIENCY, EBM, TECHNIKFOLGEN-ABSCHÄTZUNG, BIOMEDIZINISCHE, Forschungsartikel, EVALUATION STUDIES AS TOPIC, review, effectiveness, socioeconomic factors, Placeboeffekt, Prävention, preventive medicine, costs and cost analysis, decision making, socioeconomics, QUALITY OF LIFE, relaxation, Entscheidungsfindung, Mensch, PLAZEBOS, Evaluationsstudien, VALIDIERUNGSSTUDIEN, Präventivmedizin, Sozioökonomie, overweight, care, ÖKONOMIE, ÄRZTLICHE, cost control, therapy, ECONOMICS, controlled clinical trial, METABOLIC SYNDROME X, MENSCH, Technologie, medizinische, economics, PROSPECTIVE STUDIES, PLACEBO EFFECT, meta-analysis, CONTROLLED CLINICAL TRIALS AS TOPIC, health campaign, PROSPEKTIVE STUDIEN, INSULINRESISTENZ, FETTLEIBIGKEIT, PROGRAMMEVALUIERUNG, evaluation studies as topic, placebo, Entspannung, health care action, metabolic syndrome X, research-article, zerebrovaskulärer Insult, Bluthochdruck, ÜBERGEWICHT, Bewegung, apoplexia, ÖKONOMIE, Technologie, Gesundheitskampagne, GESUNDHEITSFÖRDERUNG, medizinische Beurteilung, technology assessment, biomedical, Diabetes mellitus, multicenter trial, Kostenminimierung, prevention, Kostenanalyse, cost analysis, TECHNOLOGY, MEDICAL, Blutglucose, Vorsorge, SOCIOECONOMIC FACTORS, HERZ-KREISLAUF-KRANKHEITEN, Prophylaxe, risk assessment, program evaluation, technical report, 610 Medical sciences; Medicine, meta analysis as topic, Kosten, kontrollierte klinische Versuche, kardiovaskuläre Erkrankung, cost-cutting, KLINISCHE STUDIEN, Blutzucker, HEALTH, evidenzbasierte Medizin, Primärprävention, cost reduction, primäre Prävention, COST-BENEFIT ANALYSIS, STROKE, NUTRITIONAL PHYSIOLOGICAL PHENOMENA, hypertension, effectiveness, cost, Gesundheitsfinanzierung, PLAZEBOEFFEKT, randomization, verblindet, medical costs, rehabilitation, apoplexy, blinding, program effectiveness, klinische Studien, sickness costs, Herz-Kreislauf-Krankheiten, randomisation, DECISION MAKING, crossover, HYPERTENSION, Technologiebewertung, Plazeboeffekt, accident, technology assessment, economic aspect, Reha, ethics, randomised trial, prospective studies, CCT, Gesundheitserziehung, METAANALYSE, peer review, Programmeffektivität, randomised controlled trial, randomisierte klinische Studie, EVIDENCE-BASED MEDICINE, Kostenreduktion, Krankheitskosten, health promotion, efficacy, primary prevention, kontrollierte klinische Studie, randomized controlled trials as topic, Pharmaökonomie, heart disease, ENTSCHEIDUNGSFINDUNG, cross-over-Studien, Randomisierung, PRÄVENTIVMEDIZIN, systematic review, Insult, insulin resistance, medizinische Bewertung, lipid metabolism, EVALUATIONSSTUDIEN, PRIMÄRE PRÄVENTION, behavior therapy, randomized trial, blood glucose, cross-over, KOSTEN UND KOSTENANALYSE, EFFIZIENZ, TECHNOLOGIE, MEDIZINISCHE, heart diseases, Modelle, ökonomische, clinical trials as topic, technology, medical, treatment, RISIKOABSCHÄTZUNG, juridical, CROSS-OVER STUDIES, HUMANS, medizinische Technologie, Kosteneffektivität, Kosten-Effektivität, prevention program, stroke, Technologiebeurteilung, social economic factors, BEURTEILUNG, Gesundheitsförderung, Recht, ddc: 610, economics, medical, Gesundheitssektor, randomisierte Studie, Präventionsforschung, lipometabolism, Gesundheitspolitik, Wirksamkeit, prophylaxis, Therapie, RCT, metabolisches Syndrom X, RANDOMIZED CONTROLLED TRIALS AS TOPIC, Ethik, Plazebos, Schlaganfall, ÜBERSICHTSLITERATUR, Validierungsstudien, Gesundheitswesen, blood sugar, KOSTEN-NUTZEN-ANALYSE, RELAXATION, metabolic syndrome, RANDOMISIERTE KONTROLLIERTE STUDIEN, Kosten- Effektivität, ENTSPANNUNG, Übersichtsarbeit, Spezifität, MODELLE, ÖKONOMISCHE, Verhaltenstherapie, TECHNOLOGY, Programmevaluierung, VALIDATION STUDIES AS TOPIC, cost-effectiveness, GUTACHTENBASIERTE MEDIZIN, GESUNDHEIT, Placebo, Vorbeugung, medical assessment, OVERWEIGHT, ERNÄHRUNG, Gesundheit, random, review literature, Hirnschlag, klinische Studie, GESUNDHEITSERZIEHUNG, BEHAVIOR THERAPY, blinded, pharmaeconomics, BLOOD GLUCOSE, ökonomischer Aspekt, efficiency, LIFE STYLE, placebo effect, CROSS-OVER-STUDIEN, Kostenkontrolle, gutachtenbasierte Medizin, Effektivität, high blood pressure
Stoffwechselstörung, TECHNOLOGY ASSESSMENT, BIOMEDICAL, CARDIOVASCULAR DISEASES, LIPIDSTOFFWECHSEL, Risikoabschätzung, Methodik, models, economic, Meta-Analyse, nutritional physiological phenomena, Blutglukose, randomisierte kontrollierte Studie, biomedical technology assessment, PEER REVIEW, RISK ASSESSMENT, ECONOMICS, MEDICAL, Effizienz, Pflege, humans, judgment, specifity, Präventionsprogramm, Lebensqualität, Übergewicht, Ökonomie, Übersichtsliteratur, HTA, review literature as topic, clinical trial, health policy, Rechte, BLUTGLUCOSE, Diagnose, prevention research, diabetes mellitus, technology, metabolisches Syndrom, Kostensenkung, cerebrovascular accident, randomisierte kontrollierte Studien, LEBENSQUALITÄT, SOZIALÖKONOMISCHE FAKTOREN, INSULIN RESISTANCE, HYPERTONIE, ZEREBROVASKULÄRER INSULT, kontrollierte klinische Studien, medical evaluation, DIABETES MELLITUS, Peer Review, randomisierte Zuordnung, CLINICAL TRIALS AS TOPIC, Metaanalyse, Article, methods, insult, multizentrische Studien, Zufall, Behandlung, Technikfolgen-Abschätzung, biomedizinische, health education, multicenter studies as topic, prospektive Studien, health technology assessment, validation studies, HERZKRANKHEITEN, Gesundheitsökonomie, Genauigkeitsstudie, LEBENSSTIL, MULTICENTER STUDIES AS TOPIC, life style, health economic studies, Fettstoffwechsel, Herzkrankheiten, randomized clinical trial, sensitivity, systematische Übersicht, cardiovascular diseases, HEART DISEASES, MULTIZENTRISCHE STUDIEN, Gesundheitsziele, META-ANALYSIS AS TOPIC, TECHNOLOGIE, quality of life, MODELS, ECONOMIC, randomized controlled trial, life qualities, REVIEW LITERATURE AS TOPIC, KONTROLLIERTE KLINISCHE STUDIEN, PRIMARY PREVENTION, GESUNDHEITSWESEN, Insulinresistenz, HEALTH PROMOTION, Lebensstil, meta analysis, Ernährung, PROGRAM EVALUATION, evidence based medicine, health care sector, costs, HEALTH EDUCATION, Apoplexie, Gesundheitsaktion, PLACEBOS, sozioökonomische Faktoren, randomised clinical trial, METABOLISCHES SYNDROM X, Fettleibigkeit, gesundheitsökonomische Studien, PREVENTIVE MEDICINE, Methoden, VERHALTENSTHERAPIE, Zuckerkrankheit, Hypertonie, health economics, sozialökonomische Faktoren, preventive care, LIPID METABOLISM, kardiovaskuläre Erkrankungen, Lebensqualitäten, adiposity, EbM, cost effectiveness, HEALTH POLICY, HEALTH CARE SECTOR, Lipidstoffwechsel, COSTS AND COST ANALYSIS, Rehabilitation, Beurteilung, Verblindung, health, RANDOMISIERUNG, Sensitivität, RANDOM ALLOCATION, research article, controlled clinical trials as topic, Kosten und Kostenanalyse, Kosten-Nutzen-Analyse, technology evaluation, ADIPOSITY, JUDGMENT, GESUNDHEITSPOLITIK, movement, evidence-based medicine, Herzkrankheit, randomisierter Versuch, CT, sozio-ökonomische Faktoren, EFFICIENCY, EBM, TECHNIKFOLGEN-ABSCHÄTZUNG, BIOMEDIZINISCHE, Forschungsartikel, EVALUATION STUDIES AS TOPIC, review, effectiveness, socioeconomic factors, Placeboeffekt, Prävention, preventive medicine, costs and cost analysis, decision making, socioeconomics, QUALITY OF LIFE, relaxation, Entscheidungsfindung, Mensch, PLAZEBOS, Evaluationsstudien, VALIDIERUNGSSTUDIEN, Präventivmedizin, Sozioökonomie, overweight, care, ÖKONOMIE, ÄRZTLICHE, cost control, therapy, ECONOMICS, controlled clinical trial, METABOLIC SYNDROME X, MENSCH, Technologie, medizinische, economics, PROSPECTIVE STUDIES, PLACEBO EFFECT, meta-analysis, CONTROLLED CLINICAL TRIALS AS TOPIC, health campaign, PROSPEKTIVE STUDIEN, INSULINRESISTENZ, FETTLEIBIGKEIT, PROGRAMMEVALUIERUNG, evaluation studies as topic, placebo, Entspannung, health care action, metabolic syndrome X, research-article, zerebrovaskulärer Insult, Bluthochdruck, ÜBERGEWICHT, Bewegung, apoplexia, ÖKONOMIE, Technologie, Gesundheitskampagne, GESUNDHEITSFÖRDERUNG, medizinische Beurteilung, technology assessment, biomedical, Diabetes mellitus, multicenter trial, Kostenminimierung, prevention, Kostenanalyse, cost analysis, TECHNOLOGY, MEDICAL, Blutglucose, Vorsorge, SOCIOECONOMIC FACTORS, HERZ-KREISLAUF-KRANKHEITEN, Prophylaxe, risk assessment, program evaluation, technical report, 610 Medical sciences; Medicine, meta analysis as topic, Kosten, kontrollierte klinische Versuche, kardiovaskuläre Erkrankung, cost-cutting, KLINISCHE STUDIEN, Blutzucker, HEALTH, evidenzbasierte Medizin, Primärprävention, cost reduction, primäre Prävention, COST-BENEFIT ANALYSIS, STROKE, NUTRITIONAL PHYSIOLOGICAL PHENOMENA, hypertension, effectiveness, cost, Gesundheitsfinanzierung, PLAZEBOEFFEKT, randomization, verblindet, medical costs, rehabilitation, apoplexy, blinding, program effectiveness, klinische Studien, sickness costs, Herz-Kreislauf-Krankheiten, randomisation, DECISION MAKING, crossover, HYPERTENSION, Technologiebewertung, Plazeboeffekt, accident, technology assessment, economic aspect, Reha, ethics, randomised trial, prospective studies, CCT, Gesundheitserziehung, METAANALYSE, peer review, Programmeffektivität, randomised controlled trial, randomisierte klinische Studie, EVIDENCE-BASED MEDICINE, Kostenreduktion, Krankheitskosten, health promotion, efficacy, primary prevention, kontrollierte klinische Studie, randomized controlled trials as topic, Pharmaökonomie, heart disease, ENTSCHEIDUNGSFINDUNG, cross-over-Studien, Randomisierung, PRÄVENTIVMEDIZIN, systematic review, Insult, insulin resistance, medizinische Bewertung, lipid metabolism, EVALUATIONSSTUDIEN, PRIMÄRE PRÄVENTION, behavior therapy, randomized trial, blood glucose, cross-over, KOSTEN UND KOSTENANALYSE, EFFIZIENZ, TECHNOLOGIE, MEDIZINISCHE, heart diseases, Modelle, ökonomische, clinical trials as topic, technology, medical, treatment, RISIKOABSCHÄTZUNG, juridical, CROSS-OVER STUDIES, HUMANS, medizinische Technologie, Kosteneffektivität, Kosten-Effektivität, prevention program, stroke, Technologiebeurteilung, social economic factors, BEURTEILUNG, Gesundheitsförderung, Recht, ddc: 610, economics, medical, Gesundheitssektor, randomisierte Studie, Präventionsforschung, lipometabolism, Gesundheitspolitik, Wirksamkeit, prophylaxis, Therapie, RCT, metabolisches Syndrom X, RANDOMIZED CONTROLLED TRIALS AS TOPIC, Ethik, Plazebos, Schlaganfall, ÜBERSICHTSLITERATUR, Validierungsstudien, Gesundheitswesen, blood sugar, KOSTEN-NUTZEN-ANALYSE, RELAXATION, metabolic syndrome, RANDOMISIERTE KONTROLLIERTE STUDIEN, Kosten- Effektivität, ENTSPANNUNG, Übersichtsarbeit, Spezifität, MODELLE, ÖKONOMISCHE, Verhaltenstherapie, TECHNOLOGY, Programmevaluierung, VALIDATION STUDIES AS TOPIC, cost-effectiveness, GUTACHTENBASIERTE MEDIZIN, GESUNDHEIT, Placebo, Vorbeugung, medical assessment, OVERWEIGHT, ERNÄHRUNG, Gesundheit, random, review literature, Hirnschlag, klinische Studie, GESUNDHEITSERZIEHUNG, BEHAVIOR THERAPY, blinded, pharmaeconomics, BLOOD GLUCOSE, ökonomischer Aspekt, efficiency, LIFE STYLE, placebo effect, CROSS-OVER-STUDIEN, Kostenkontrolle, gutachtenbasierte Medizin, Effektivität, high blood pressure
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