The long-term improvement of risk-factors for cardiovascular diseases by residential rehabilitation – results of a three-years-period – calculation of the economical benefit
About 3 years after discharge from residential
rehabilitation, patients affected with cardiovascular risk factors
show a significant average reduction in blood pressure
(-20 mmHg systolic, -10 mmHg diastolic values).
The fraction of patients with manifest
hypertension has been reduced in the long-term by
about 50 %. The fraction of patients with pathologically high lipid serum levels
has been reduced in the long-term by about 50 % (for example
reduction of cholesterin levels by 14 % or 35 mg/dl, reduction of LDL levels by 20 % or 40 mg/dl, reduction of the cholesterin-HDL-quotient by 18 % or 1,0). A long term improvement of pathological increases in body
weight was achievable in 95 % of the patients; the mean reduction of body weight
was 3,4 kg. The fraction of patients with obesity (exceeding the “Broca” normal weight by more than 20 %)
has been reduced in the long-term by 22 %; a long
term complete normalization of body weight was achievable in 22 % of the patients.
Based on these significant results, and based on puplished intervention
trials, epidemiological and economical dates, the cost benefit of residential rehabilitation was calculated with regard to the 80 million
population of the German Republic. According to published epidemiologic and
economic data from several authors, the calculations were based on the following basal parameters
applied to Germany:
- average individual cost of a three-week residential rehabilitation care: EUR 1700,00 per head
- total individual costs of cardiovascular diseases (56 % direct and 44 % indirect costs) per annum and per head: EUR 3100,00
- total fiscal costs of cardiovascular diseases (direct and indirect costs) per annum: EUR 15
- total costs of drugs in cardiovascular diseases per annum: EUR 5
billion (30,7 % of all drugs)
- total costs of antihypertensive drugs per annum: EUR 2,5
billion (15,4 % of all drugs)
- total costs of hospital treatments associated with cardiovascular diseases per annum: EUR 9
billion (18 % of all hospital costs)
- total costs of treatments associated with obesity per annum: EUR 250
billion (6 % of all treatment costs)
- number of patients with coronary heart disease in Germany: 2,5
- number of patients with cerebrovascular diseases in Germany: 6,0
- number of patients with acute myocardial infarctions per annum: 282 000
- number of patients with acute stroke per annum: 175 000
- number of hospital treatments associated with cardiovascular diseases per annum: 2,4
million (16 % of all hospital cases).
Based on published results of several intervention studies and associated with the long-term reductions of cardiovascular risk factors, reductions of incidences for cardiovascular diseases achievable by a
three-week residential rehabilitation can be estimated as follows:
- for all patients with hypertension: minus
approx. 35 % (minus 32 % for myocardial infarctions, minus 36 % for strokes)
- for all patients with
dyslipidemia: minus approx. 17 %
- for all patients with obesity: minus
approx. 11 %
- for all rehabilitation
patients: minus approx. 21 % (average value).
A three week rehabilitation will be amortized, if the incidence of cardiovascular complications is
reduced in the long-term by 18 %. The incidence of these complications will be reduced by 35 % in cases of hypertension, by
17 % in cases of dyslipidemia, by 11 % in cases of obesity. The average reduction of the incidence of cardiovascular complications for all cases will be about 21 % as mentioned above.
Further amortisations can be calculated based on the delay of the manifestations of cardiovascular complications. Thus, after the period of rehabilitation, a three week rehabilitation will be amortized, when the
manifestation of cardiovascular complications is delayed by 0,56 years in cases of hypertension, by 1,2 years in cases of dyslipidemia and by 2,5 years in cases of obesity. Further cost benefits can be expected
long term improvement of pathological increases in body weight produces positive influences on several other diseases, correlated with obesity (e.g. cancer, arthrosis and intervertebral disk degenerations).
The long-term improvement of risk factors for cardiovascular diseases by inpatient rehabilitation.
- results of a three-years-period-calculation of the economical benefit (in German)
Praev.-Rehab., 12 / 1, 31-44, Dustri, 2000
Copyright: Joerg Piper, Bad Bertrich, Germany, 2010