Cost-effectiveness of cardiac rehabilitation program delivery models in patients at varying cardiac risk, reason for referral, and sex.
BACKGROUND
Little is known about the relative cost-effectiveness of different secondary prevention cardiac rehabilitation (CR) program designs or how cost-effectiveness is influenced by patient clinical and demographic characteristics. The purpose of the study was (i) to evaluate the incremental cost-effectiveness of a standard 3-month CR program (SCR) versus a program distributed over 12 months (distributed CR, DCR); and (ii) to determine the effect of patient demographic characteristics (cardiac risk, cardiac diagnosis, sex) on incremental cost-effectiveness.


METHODS
A two group cost-effectiveness analysis was conducted alongside a randomized controlled trial. Patients with coronary artery disease (mean age=58 years, SD+/-10) were randomized to either SCR (n=196) or DCR (n=196) and followed for 24 months. Program delivery costs, cardiac healthcare use, morbidity, mortality, and quality-adjusted life years were assessed. Cost-effectiveness was evaluated with incremental cost-utility analysis.


RESULTS
In the pooled analysis, we found the probability of SCR being more cost-effective than DCR was 63-67%. The subanalysis found SCR to be the more cost-effective intervention for patients at high risk, patients with previous coronary artery bypass graft and for male patients. The DCR program was more cost-effective for patients with lower risk of disease progression and for female patients.


CONCLUSIONS
Differences were noted in the cost-effectiveness of CR models based on cardiac risk level, reason for referral, and demographic characteristics. Our results suggest improved cost-effectiveness may be gained by triaging patients to different CR intervention models, however, further investigation is required.
MINTO Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. SPapadakis@ottawaheart.ca
Sophia
S
Papadakis
Robert D
RD
Reid
Doug
D
Coyle
Louise
L
Beaton
Douglas
D
Angus
Neil
N
Oldridge
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation; D012046:Rehabilitation / Q000191:economics / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors