Home-based cardiac rehabilitation versus hospital-based rehabilitation: a cost effectiveness analysis.
BACKGROUND
Home-based cardiac rehabilitation offers an alternative to traditional, hospital-based cardiac rehabilitation.


OBJECTIVE
To compare the cost effectiveness of home-based cardiac rehabilitation and hospital-based cardiac rehabilitation.


METHODS
104 patients with an uncomplicated acute myocardial infarction and without major comorbidity were randomized to receive home-based rehabilitation (n=60) i.e. nurse facilitated, self-help package of 6 weeks' duration (the Heart Manual) or hospital-based rehabilitation for 8-10 weeks (n=44). Complete economic data were available in 80 patients (48 who received home-based rehabilitation and 32 who received hospital-based rehabilitation). Healthcare costs, patient costs, and quality of life (EQ-5D4.13) were assessed over the 9 months of the study.


RESULTS
The cost of running the home-based rehabilitation programme was slightly lower than that of the hospital-based programme (mean (95% confidence interval) difference - 30 pounds sterling (- 45 pounds sterling to - 12 pounds sterling) [-44 euro, -67 euro to -18 euro] per patient. The cost difference was largely the result of reduced personnel costs. Over the 9 months of the study, no significant difference was seen between the two groups in overall healthcare costs (78 pounds sterling, - 1102 pounds sterling to 1191 pounds sterling [-115 euro, -1631 euro to -1763 euro] per patient) or quality adjusted life-years (-0.06 (-0.15 to 0.02)). The lack of significant difference between home-based rehabilitation and hospital-based rehabilitation did not alter when different costs and different methods of analysis were used.


CONCLUSIONS
The health gain and total healthcare costs of the present hospital-based and home-based cardiac rehabilitation programmes for patients after myocardial infarction appear to be similar. These initial results require affirmation by further economic evaluations of cardiac rehabilitation in different settings.
Taylor
R S
RS
Peninsula Medical School, UK. rod.taylor@pms.ac.uk
Watt
A
A
Dalal
H M
HM
Evans
P H
PH
Campbell
J L
JL
Read
K L Q
KL
Mourant
A J
AJ
Wingham
Jenny
J
Thompson
D R
DR
Pereira  Gray
D J
DJ
D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D006305:Health Status Indicators; D018575:Home Care Services, Hospital-Based / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000534:rehabilitation*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation / Q000191:economics