[Cost/benefit relations: evaluation of inpatient and ambulatory rehabilitation]

Three different forms of rehabilitation in patients after myocardial infarction are discussed on the basis of cost-effectiveness: 1) outpatient rehabilitation as performed in North America and other developed countries, 2) inpatient rehabilitation in Germany, and 3) outpatient rehabilitation in Germany. Parameters compared are mortality, coronary risk factor profile, and return to work. A metaanalysis of international studies on outpatient rehabilitation demonstrated a significant reduction of total and cardiovascular mortality. Similar data are not available for inpatient rehabilitation in Germany. However, data of 6 years of outpatient rehabilitation as performed in the "Heidelberg Study" demonstrate a continuous significant improvement in coronary risk factor profile and cardiopulmonary fitness. On the other hand, 4 weeks of inpatient rehabilitation exhibited only short-term and no long-lasting effects (4 years) on coronary risk factor profile. The economic benefit can be based on return to work, which is only marginally affected by rehabilitation in the USA, where more than 80% of the patients are back to work 6 months after myocardial infarction. In Germany, about 5 months after myocardial infarction 50% of the patients are retired, despite 4-6 weeks inpatient rehabilitation; i.e., the patients which are back to work can be assumed to be less than 50%. The costs of 8 weeks outpatient rehabilitation in North America has been calculated to be 804 DM per patient, 4 weeks of inpatient rehabilitation amounts to about 5320-5600 DM, and 1 year ambulatory treatment in the "Heidelberg Study" accounts for 2270 DM per patient. It can be concluded: outpatient rehabilitation as performed in North America has been shown to significantly reduce total and cardiovascular mortality.(ABSTRACT TRUNCATED AT 250 WORDS)