title: Home-based cardiac rehabilitation versus hospital-based rehabilitation: a cost effectiveness analysis.
abstract: 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.
authors.affiliation: Peninsula Medical School, UK. rod.taylor@pms.ac.uk
authors.forename: R S
authors.initials: RS
authors.lastname: Taylor
authors.forename: A
authors.initials: A
authors.lastname: Watt
authors.forename: H M
authors.initials: HM
authors.lastname: Dalal
authors.forename: P H
authors.initials: PH
authors.lastname: Evans
authors.forename: J L
authors.initials: JL
authors.lastname: Campbell
authors.forename: K L Q
authors.initials: KL
authors.lastname: Read
authors.forename: A J
authors.initials: AJ
authors.lastname: Mourant
authors.forename: Jenny
authors.initials: J
authors.lastname: Wingham
authors.forename: D R
authors.initials: DR
authors.lastname: Thompson
authors.forename: D J
authors.initials: DJ
authors.lastname: Pereira  Gray
mesh_terms: 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