title: Cost-effectiveness of new cardiac and vascular rehabilitation strategies for patients with coronary artery disease.
abstract: OBJECTIVE
  Peripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD) undergoing cardiac rehabilitation.
  
  
  METHODS
  Best-available evidence was retrieved from literature and combined with primary data from 231 patients.
  
  
  METHODS
  We developed a markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI) if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs), life-time costs (US $), incremental cost-effectiveness ratios (ICER), and gain in net health benefits (NHB) in QALY equivalents were calculated. A threshold willingness-to-pay of $75,000 was used.
  
  
  RESULTS
  ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44,251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: -0.17, 0.29) at a threshold willingness-to-pay of $75,000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30,246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:-0.24, 0.46) compared to current practice. The results were robust for other different input parameters.
  
  
  CONCLUSIONS
  ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands. s.spronk@erasmusmc.nl
authors.forename: Sandra
authors.initials: S
authors.lastname: Spronk
authors.forename: Johanna L
authors.initials: JL
authors.lastname: Bosch
authors.forename: Constance
authors.initials: C
authors.lastname: Ryjewski
authors.forename: Judith
authors.initials: J
authors.lastname: Rosenblum
authors.forename: Guido C
authors.initials: GC
authors.lastname: Kaandorp
authors.forename: John V
authors.initials: JV
authors.lastname: White
authors.forename: M G Myriam
authors.initials: MG
authors.lastname: Hunink
mesh_terms: D003324:Coronary Artery Disease / Q000191:economics* / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D006262:Health; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States