Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation.
BACKGROUND
Since the late 1990 s, cost pressure has led to a growing interest in outpatient rehabilitation in Germany where predominantly inpatient rehabilitation has been provided. Taking into account the feasibility of a randomized design, the aim of this study was to compare outpatient and inpatient cardiac rehabilitation from a societal perspective.


METHODS
A comprehensive cohort design was applied. Costs during rehabilitation were measured using individual documentation of the rehabilitation centers. Economic end points were quality of life (EQ-5D), and total direct and indirect costs. A propensity score approach, integrated into a simultaneous regression framework for cost and effects, was used to control for selection bias. Bootstrap analysis was applied for assessing uncertainty in cost-effectiveness.


RESULTS
A total of 163 patients were included in the study (112 inpatients, 51 outpatients). As randomization was chosen by only 2.5% of participants, the study had to be analyzed as an observational study. Direct costs during inpatient rehabilitation were significantly higher by 600 euro (+/-318; p < 0.001) compared to outpatient rehabilitation (2,016 euro +/- 354 euro vs. 1,416 euro +/- 315), while there was no significant difference in health-related quality of life. Over the 12-month follow-up period, adjusted costs difference in total cost was estimated at -2,895 euro (p = 0.102) and adjusted difference in effects at 0.018 quality-adjusted life years (QALYs) (n.s.) in favor of outpatient treatment.


CONCLUSIONS
The ratio of mean cost over mean effect difference (incremental cost-effectiveness ratio) indicates dominance of outpatient rehabilitation, but at a considerable statistical uncertainty. However, outpatient rehabilitation cannot be rejected from an economic perspective.
Schweikert
Bernd
B
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, P.O.Box 1129, 85758, Neuherberg, Germany. bernd.schweikert@helmholtz-muenchen.de
Hahmann
Harry
H
Steinacker
Jürgen M
JM
Imhof
Armin
A
Muche
Rainer
R
Koenig
Wolfgang
W
Liu
Yufei
Y
Leidl
Reiner
R
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000534:rehabilitation*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012047:Rehabilitation Centers / Q000191:economics*; D015983:Selection Bias