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Objective of the Study: Health valuations are one way of measuring patient preferences with respect to the results of their treatment. The study examines three different methods of health valuations--willingness to pay (WTP), visual analogue scale (VAS), and a rating question for evaluating the subjective significance. The goal is to test the understandability and acceptance of these methods for implementation in questionnaires., Method: In various rehabilitation centres, a total of six focus groups were conducted with 5-9 patients each with a mean age of 57.1 years. The illnesses considered were chronic-ischaemic heart disease, chronic back pain, and breast cancer. Patients filled out a questionnaire that was then discussed in the group. In addition to the quantitative evaluation of the data in the questionnaire, a qualitative analysis of the contents of the group discussion protocols was made., Results: We have results from a total of 42 patients. 14.6% of the patients had "great difficulties" understanding the WTP or rated it as "completely incomprehensible"; this value was 7.3% for VAS and 0% for the rating scale. With respect to acceptance, 31.0% of the patients indicated that they were "not really" or "not at all" willing to answer such a WTP question in a questionnaire; this was 6.6% for the VAS, and again 0% for the rating scale. The qualitative analysis provided an indication as to why some patients view the WTP question in particular in a negative light. Many difficulties in understanding it were related to the formulation of the question and the structure of the questionnaire. However, the patients' statements also made it apparent that the hypothetical nature of the WTP questionnaire was not always recognised. The most frequent reason for the lack of acceptance of the WTP was the patients' fear of negative financial consequences of their responses., Discussion: With respect to understandability and acceptance, VAS questions appear to be better suited for reflecting patient preferences than WTP questions. The rating scale for assessing the personally estimated importance was understandable, but had poor distribution properties and was considered by patients to be superfluous.

The effects of an outhospital cardiac rehabilitation program in "heart groups" (HG) are studied in a case-control design. The control group (KG) was collected by match-pairing from 12,560 cases of a rehabilitation clinic fitting in the relevant criteria to those of members of the HG. Patients of both groups (n = 75/group) after myocardial infarction and CABG were followed up over 7.5 years. There was no significant difference in risk factor modification. Exercise tolerance improved significantly in the HG by increasing maximum work capacity by 50% in spite of a mean age of 60 years at the beginning. Members of HG had significantly lesser cardiac complaints and lower need for cardiac medication. Cardiac morbidity was reduced by 54% and costs for medical care were lowered by 47% in HG. Although effects of secondary prevention on reducing risk factors were still insufficient, exercise tolerance in higher age and quality of life were improved, reduction in medication and in the morbidity saved costs for the health system.

Background: In patients with stable angina pectoris or silent myocardial ischemia, who had signs of ischemia in ECG during exercise, the Asymptomatic Cardiac Ischemia Pilot (ACIP) study compared 2 types of medication strategies (ischemia-guided and angina-guided) and a strategy of primary revascularization by PTCA or CABG. ACIP substantiated, after 2 years of observation, a clear advantage of the revascularization strategy compared to both drug strategies in terms of clinical effectiveness. This advantage is even more distinct in patients with very severe angiographic results., Patients and Methods: This is a retrospective, incremental cost-effectiveness analysis from the perspective of the German third party payer (statutory sick funds) on the basis of the ACIP study., Results: The direct costs of the revascularization strategy after 2 years are about 2 to 3 times higher than those of the drug therapies. The incremental cost-effectiveness of the ischemia-guided strategy versus an angina-guided strategy is DM 2,600 per life-year saved. Furthermore, the cost-effectiveness of a revascularization strategy versus an angina guided therapy is DM 15,100 per life-year saved., Conclusion: A primary revascularization strategy is cost-effective in patients with stable coronary artery disease with proven myocardial ischemia and positive angiographic signs.