Lessons learned from prevention programs: different endpoints should be used in secondary and tertiary prevention.

It is mandatory to compare cost and consequences of healthcare services if public support is requested. This request will apply to all healthcare services including prevention. As the demand for health care will always exceed the available resources, methods that make it possible to select the "best" programs for implementation have to be developed. The selection of the "best" programs is not easy because there exist so far no generally accepted quality criteria that can be used to identify the "best" prevention programs.Based on a model on structural and functional properties of a disease, it is concluded that the traditional outcomes of treatment and prevention may be useful for the evaluation of tertiary prevention programs, but not of secondary prevention programs. Neither the traditional endpoints of treatment studies nor traditional surrogate parameters are useful for the evaluation of secondary prevention programs.Using the assumptions of the model and a list of available data in secondary prevention programs we recommend to assess five indicators for description of the value of a secondary prevention program: quality of life, surrogates for life expectancy, the perspective of the assessor, the conditions of assessment, and finally the payment. As each of these five items offers two possible values prevention programs may be classified into 32 different groups.