cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2013-1-60-66cardiovascular-111Research ArticleПРОФИЛАКТИКА СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙРREVENTION OF CARDIOVASCULAR DISEASESДОЛГОСРОЧНАЯ ЭКОНОМИЧЕСКАЯ ЭФФЕКТИВНОСТЬ ПРОГРАММЫ МНОГОФАКТОРНОЙ ПРОФИЛАКТИКИ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ В ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИLONG-TERM ECONOMIC EFFECTIVENESS OF THE MULTIFACTORIAL CARDIOVASCULAR PREVENTION PROGRAMME IN THE CONTEXT OF PRIMARY HEALTH CAREКалининаА. М.KalininaA. M.

руководитель отдела первичной профилактики хронических неинфекционных заболеваний в системе здравоохранения

akalinina@gnicpm.ruКонцеваяА. В.KontsevayaA. V.

ведущий научный сотрудник отдела

ДеевА. Д.DeevA. D.

руководитель лаборатории биостатистики

ФГБУ ГНИЦ Профилактической медицины Минздрава РоссииState Research Centre for Preventive Medicine, Moscow2013200220131216066Copyright © Калинина А.М., Концевая А.В., Деев А.Д., 20132013Калинина А.М., Концевая А.В., Деев А.Д.Kalinina A.M., Kontsevaya A.V., Deev A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/111

Проведен анализ экономического эффекта программы многофакторной профилактики сердечно-сосудистых заболеваний (ССЗ) с позиции оценки сохранения в результате профилактического вмешательства трудового потенциала. Программа многофакторной профилактики ССЗ — одно из немногих, отечественных, контролируемых исследований, которое проведено в условиях первичного амбулаторно-поликлинического звена, на популяционной когорте лиц среднего возраста c активным профилактическим вмешательством в течение 5 лет, и мониторинг за конечными точками в течение 10 лет. В настоящей работе проведен вторичный анализ (post-hoc analysis) с применением современных интегральных индикаторов оценки — сохраненные годы жизни (LYS) и расчетов экономической эффективности программы. В популяции активной профилактики в течение 5 лет удалось сохранить 52,5 года жизни на 1 тыс. участников программы, кумулятивный показатель за 10 лет наблюдения составил 147,4 LYS. Затраты в течение 5 лет реализации программы на 1 LYS — 85 512,4 руб. и в течение 10 лет — 41 679,3 руб. были существенно ниже ВВП (290 000 руб.), производимого 1 работником в год, а возврат инвестиций в профилактику ССЗ составил 2,3 руб. на каждый вложенный руб. в течение 5 лет и 5,8 руб.— в течение 10 лет. Многофакторная медицинская профилактика ССЗ при внедрении в повседневную практику амбулаторно-поликлинических учреждений экономически эффективна и целесообразна. 

Economic effects of the multifactorial cardiovascular prevention programme are analysed in the context of prevention-associated preserved work potential. The programme of multifactorial prevention of cardiovascular disease (CVD) is one of the few Russian controlled studies, which was performed in the primary health care settings, in the population-based middle-aged cohort, and included both the active preventive intervention (5 years) and the end-point follow-up (10 years). This study is a post-hoc analysis employing modern parameters of integrated assessment, such as life-years saved (LYS) and estimated cost-effectiveness of the programme. In the active prevention population, the 5-year intervention saved 52,5 life-years per 1000 participants, with the cumulative 10-year LYS number of 147,4. The programme costs per 1 LYS (85512,4 roubles for 5 years and 41679,3 roubles for 10 years) were significantly lower than the gross domestic product per one worker per year (290000 roubles). The payback of the CVD prevention investment (per 1 rouble invested) reached 2,3 roubles for 5 years and 5,8 roubles for 10 years. Multifactorial medical prevention of CVD is economically effective and justifiable when integrated into the routine practice of primary health care. 

первичная медико-санитарная помощьпрограммы профилактикисердечно-сосудистые заболеванияэкономическая эффективностьпопуляционные показатели эффективностигоды сохраненной жизнигоды сохраненной качественной жизниprimary health careprevention programmescardiovascular diseaseeconomic effectivenesspopulation-level effectiveness parameterslife-years savedquality-adjusted life-years savedReferencesOganov RG, Kontsevaya AV, Kalinina AM. Economic cost of cardiovascular diseases in the Russian Federation. Cardiovascular therapy and prevention 2011; 4: 4–9. Russian (Оганов Р. Г., Концевая А.В., Калинина А. М. Экономический ущерб от сердечно-сосудистых заболеваний в Российской Федерации. Кардиоваскулярная терапия и профилактика 2011; 4: 4–9).Oganov RG, Kontsevaya AV, Kalinina AM. Economic cost of cardiovascular diseases in the Russian Federation. Cardiovascular therapy and prevention 2011; 4: 4–9. Russian (Оганов Р. Г., Концевая А.В., Калинина А. М. Экономический ущерб от сердечно-сосудистых заболеваний в Российской Федерации. Кардиоваскулярная терапия и профилактика 2011; 4: 4–9).Lloyd-Jones D, Adams R, Carnethon M. et al. Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: 480–6.Lloyd-Jones D, Adams R, Carnethon M. et al. Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: 480–6.Chapman LS. Meta-evaluation of worksite health promotion economic return studies: 2005 update. Am J Health Promot 2005; 19: 1–11.Chapman LS. Meta-evaluation of worksite health promotion economic return studies: 2005 update. Am J Health Promot 2005; 19: 1–11.Goetzel RZ, Ozminkowski RJ. The Health and Cost Benefits of Work Site Health-Promotion Programs. Ann Rev Pub Health 2008; 29: 303–23.Goetzel RZ, Ozminkowski RJ. The Health and Cost Benefits of Work Site Health-Promotion Programs. Ann Rev Pub Health 2008; 29: 303–23.Lindenbraten AL Resources require thrift. Social Security 2010; 6: 22–6. Russian (Линденбратен А.Л. Ресурсы требуют бережливости. Социальное страхование 2010; 6: 22–6).Lindenbraten AL Resources require thrift. Social Security 2010; 6: 22–6. Russian (Линденбратен А.Л. Ресурсы требуют бережливости. Социальное страхование 2010; 6: 22–6).Goldman L, Phillips KA, Coxson P, et al. The effect of risk factor reductions between 1981 and 1990 on coronary heart disease incidence, prevalence, mortality and cost. JACC 2001; 38: 1012–7.Goldman L, Phillips KA, Coxson P, et al. The effect of risk factor reductions between 1981 and 1990 on coronary heart disease incidence, prevalence, mortality and cost. JACC 2001; 38: 1012–7.Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med 2008; 358 (7): 661–3.Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med 2008; 358 (7): 661–3.Woolf SH. A Closer Look at the Economic Argument for Disease Prevention. JAMA 2009; 301 (5): 536–8.Woolf SH. A Closer Look at the Economic Argument for Disease Prevention. JAMA 2009; 301 (5): 536–8.Chazova LV. Multifactorial prevention of coronary heart disease in the population. Doctor diss Moscow 1984; 38 p. Russian (Чазова Л.В. Многофакторная профилактика ишемической болезни сердца среди населения. Автореф дисс докт мед наук. Москва 1984; 38 с).Chazova LV. Multifactorial prevention of coronary heart disease in the population. Doctor diss Moscow 1984; 38 p. Russian (Чазова Л.В. Многофакторная профилактика ишемической болезни сердца среди населения. Автореф дисс докт мед наук. Москва 1984; 38 с).Kalinina AM. The effect of prolonged multifactorial prevention of coronary heart disease by several indicators of health and life prognosis (10-year follow-up). Diss. Doctor. Moscow 1993; 46 p. Russian (Калинина А.М. Влияние длительной многофакторной профилактики ишемической болезни сердца на некоторые показатели здоровья и прогноз жизни (10-летнее наблюдение). Автореф дисс докт мед наук. Москва 1993; 46 с).Kalinina AM. The effect of prolonged multifactorial prevention of coronary heart disease by several indicators of health and life prognosis (10-year follow-up). Diss. Doctor. Moscow 1993; 46 p. Russian (Калинина А.М. Влияние длительной многофакторной профилактики ишемической болезни сердца на некоторые показатели здоровья и прогноз жизни (10-летнее наблюдение). Автореф дисс докт мед наук. Москва 1993; 46 с).Kalinina AM Scientific evidence of cardiovascular prevention in medical practice (to the 35th anniversary of the start of the study, “Multi-factor prevention of coronary heart disease among the unorganized population”) 35 years –35 lessons. Cardiovascular Therapy and Prevention, 2010; 1: 14–20. Russian (Калинина А. М. Научные доказательные факты профилактики сердечно-сосудистых заболеваний в практическом здравоохранении (к 35-летию от начала исследования «Многофакторная профилактика ишемической болезни сердца среди неорганизованного населения») 35 лет — 35 уроков. Кардиоваскулярная терапия и профилактика 2010; 1: 14–20).Kalinina AM Scientific evidence of cardiovascular prevention in medical practice (to the 35th anniversary of the start of the study, “Multi-factor prevention of coronary heart disease among the unorganized population”) 35 years –35 lessons. Cardiovascular Therapy and Prevention, 2010; 1: 14–20. Russian (Калинина А. М. Научные доказательные факты профилактики сердечно-сосудистых заболеваний в практическом здравоохранении (к 35-летию от начала исследования «Многофакторная профилактика ишемической болезни сердца среди неорганизованного населения») 35 лет — 35 уроков. Кардиоваскулярная терапия и профилактика 2010; 1: 14–20).Chazova LV, IS Glazunov, Oleynikov SP, et al. Multifactorial prevention of coronary heart disease. Mосква 1983; 131. Russian (Чазова Л.В., Глазунов И.С., Олейников С.П. и др. Многофакторная профилактика ишемической болезни сердца. Москва 1983; 131 с).Chazova LV, IS Glazunov, Oleynikov SP, et al. Multifactorial prevention of coronary heart disease. Mосква 1983; 131. Russian (Чазова Л.В., Глазунов И.С., Олейников С.П. и др. Многофакторная профилактика ишемической болезни сердца. Москва 1983; 131 с).Vorobyev PA, Avksenteva MV, Yurjev AS, et al. Clinical and economic analysis. M. Nyudiamed 2004; 404 p. Russian (Воробьев П. А., Авксентьева М.В., Юрьев А.С. и др. Клинико-экономический анализ. М.: Ньюдиамед 2004; 404 с).Vorobyev PA, Avksenteva MV, Yurjev AS, et al. Clinical and economic analysis. M. Nyudiamed 2004; 404 p. Russian (Воробьев П. А., Авксентьева М.В., Юрьев А.С. и др. Клинико-экономический анализ. М.: Ньюдиамед 2004; 404 с).Sarkar U, Ali S, Whooley MA. Self-Efficacy and Health Status in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study Psychosomatic Medicine 2007; 69: 306–12.Sarkar U, Ali S, Whooley MA. Self-Efficacy and Health Status in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study Psychosomatic Medicine 2007; 69: 306–12.Tengs TO, Yu M, Luistro E. Health-related quality of life after stroke a comprehensive review. Stroke 2001; 32 (4): 964–72.Tengs TO, Yu M, Luistro E. Health-related quality of life after stroke a comprehensive review. Stroke 2001; 32 (4): 964–72.Caro J, Klittich W, McGuire A, et al, for the West of Scotland Coronary Prevention Study Group. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin. BMJ 1997; 315: 1577–82.Caro J, Klittich W, McGuire A, et al, for the West of Scotland Coronary Prevention Study Group. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin. BMJ 1997; 315: 1577–82.Mihaylova B, Briggsb A, Armitage J, et al. Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people. BMJ 2006; 333 (7579): 1145–8.Mihaylova B, Briggsb A, Armitage J, et al. Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people. BMJ 2006; 333 (7579): 1145–8.Grover S, Coupal L, Lowensteyn I. Preventing cardiovascular disease among Canadians: is the treatment of hypertension or dyslipidemia cost￾effective? Can J Cardiol 2008; 24 (12): 891–8.Grover S, Coupal L, Lowensteyn I. Preventing cardiovascular disease among Canadians: is the treatment of hypertension or dyslipidemia cost￾effective? Can J Cardiol 2008; 24 (12): 891–8.Bemelmans W, van Baal P, Wendel-Vos W, et al. The costs, effects and cost-effectiveness of counteracting overweight on a population level: a scientific base for policy targets for the Dutch national plan for action. Prev Med 2008; 46: 127–32.Bemelmans W, van Baal P, Wendel-Vos W, et al. The costs, effects and cost-effectiveness of counteracting overweight on a population level: a scientific base for policy targets for the Dutch national plan for action. Prev Med 2008; 46: 127–32.Salkeld G, Phongsavan P, Oldenburg B, et al. The cost-effectiveness of a cardiovascular risk reduction program in general practice. Health Policy 1997; 41 (2): 105–19.Salkeld G, Phongsavan P, Oldenburg B, et al. The cost-effectiveness of a cardiovascular risk reduction program in general practice. Health Policy 1997; 41 (2): 105–19.Finkelstein E, French S, Variyam JN, Haines PS. Pros and Cons of Proposed Interventions to Promote Healthy Eating. Am J Prev Med 2004; 27 (3): 163–71.Finkelstein E, French S, Variyam JN, Haines PS. Pros and Cons of Proposed Interventions to Promote Healthy Eating. Am J Prev Med 2004; 27 (3): 163–71.Tice JA, Ross E, Coxson PG, et al. Cost-effectiveness of vitamin therapy to lower plasma homocysteine levels for the prevention of coronary heart disease: effect of grain fortification and beyond. JAMA 2001; 286: 936–43.Tice JA, Ross E, Coxson PG, et al. Cost-effectiveness of vitamin therapy to lower plasma homocysteine levels for the prevention of coronary heart disease: effect of grain fortification and beyond. JAMA 2001; 286: 936–43.Plans-Rubi P. Cost-Effectiveness of Cardiovascular Prevention Programs in Spain. Intern J Technology Assessment in Health Care 1998; 14: 320–30.Plans-Rubi P. Cost-Effectiveness of Cardiovascular Prevention Programs in Spain. Intern J Technology Assessment in Health Care 1998; 14: 320–30.Tosteson АNA, Weinstein MC, Hunink MGM. Cost-Effectiveness of Populationwide Educational Approaches to Reduce Serum Cholesterol Levels. Circulation 1997; 95: 24–30.Tosteson АNA, Weinstein MC, Hunink MGM. Cost-Effectiveness of Populationwide Educational Approaches to Reduce Serum Cholesterol Levels. Circulation 1997; 95: 24–30.Lindgren P, Fahlstadius P, Hellenius ML, et al. Cost-effectiveness of primary prevention of coronary heart disease through risk factor intervention in 60-year-old men from the county of Stockholm — a stochastic model of exercise and dietary advice. Prev Med 2003; 36 (4): 403–9.Lindgren P, Fahlstadius P, Hellenius ML, et al. Cost-effectiveness of primary prevention of coronary heart disease through risk factor intervention in 60-year-old men from the county of Stockholm — a stochastic model of exercise and dietary advice. Prev Med 2003; 36 (4): 403–9.Lindholm L, Rosen M, Weinehall L, Asplund K. Cost effectiveness and equity of a community based cardiovascular disease prevention programme in Norsjo, Sweden. J Epidem Comm Health 1996; 50: 190–5.Lindholm L, Rosen M, Weinehall L, Asplund K. Cost effectiveness and equity of a community based cardiovascular disease prevention programme in Norsjo, Sweden. J Epidem Comm Health 1996; 50: 190–5.

The authors declare that there are no conflicts of interest present.