Cost-effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial.
OBJECTIVE
To estimate the incremental effects on cost and quality of life of cardiac rehabilitation after an acute coronary syndrome.


METHODS
Open randomised controlled trial with 1 year's follow-up. Analysis was on an intention-to-treat basis.


METHODS
Two tertiary hospitals in Sydney.


METHODS
18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor.


METHODS
113 patients aged 41-75 years who were self-caring and literate in English. Patients with uncompensated heart failure, uncontrolled arrhythmias, severe and symptomatic aortic stenosis or physical impairment were excluded.


METHODS
Costs (hospitalisations, medication use, outpatient visits, investigations, and personal expenses); and measures of quality of life. Incremental cost per quality-adjusted life year (QALY) saved at 1 year (this estimate combines within-study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality). Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival, 3 years of treatment effect on survival and variations in utility.


RESULTS
The estimated incremental cost per QALY saved for rehabilitation relative to standard care was 42,535 US dollars when modelling included the reported treatment effect on survival. This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included. The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective.


CONCLUSIONS
The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome. The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee.
Briffa
Tom G
TG
NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
Eckermann
Simon D
SD
Griffiths
Alison D
AD
Harris
Phillip J
PJ
Heath
M Rose
MR
Freedman
Saul B
SB
Donaldson
Lana T
LT
Briffa
N Kathryn
NK
Keech
Anthony C
AC
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000191:economics* / Q000534:rehabilitation*; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D005081:Exercise Therapy / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000534:rehabilitation*; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years