title: Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation.
abstract: 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.
authors.affiliation: 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
authors.forename: Bernd
authors.initials: B
authors.lastname: Schweikert
authors.forename: Harry
authors.initials: H
authors.lastname: Hahmann
authors.forename: Jürgen M
authors.initials: JM
authors.lastname: Steinacker
authors.forename: Armin
authors.initials: A
authors.lastname: Imhof
authors.forename: Rainer
authors.initials: R
authors.lastname: Muche
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.forename: Yufei
authors.initials: Y
authors.lastname: Liu
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
mesh_terms: 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