title: Cost-effectiveness of supervised exercise therapy in heart failure patients.
abstract: OBJECTIVE
  Exercise therapy in heart failure (HF) patients is considered safe and has demonstrated modest reduction in hospitalization rates and death in recent trials. Previous cost-effectiveness analysis described favorable results considering long-term supervised exercise intervention and significant effectiveness of exercise therapy; however, these evidences are now no longer supported. To evaluate the cost-effectiveness of supervised exercise therapy in HF patients under the perspective of the Brazilian Public Healthcare System.
  
  
  METHODS
  We developed a Markov model to evaluate the incremental cost-effectiveness ratio of supervised exercise therapy compared to standard treatment in patients with New York Heart Association HF class II and III. Effectiveness was evaluated in quality-adjusted life years in a 10-year time horizon. We searched PUBMED for published clinical trials to estimate effectiveness, mortality, hospitalization, and utilities data. Treatment costs were obtained from published cohort updated to 2008 values. Exercise therapy intervention costs were obtained from a rehabilitation center. Model robustness was assessed through Monte Carlo simulation and sensitivity analysis. Cost were expressed as international dollars, applying the purchasing-power-parity conversion rate.
  
  
  RESULTS
  Exercise therapy showed small reduction in hospitalization and mortality at a low cost, an incremental cost-effectiveness ratio of Int$26,462/quality-adjusted life year. Results were more sensitive to exercise therapy costs, standard treatment total costs, exercise therapy effectiveness, and medications costs. Considering a willingness-to-pay of Int$27,500, 55% of the trials fell below this value in the Monte Carlo simulation.
  
  
  CONCLUSIONS
  In a Brazilian scenario, exercise therapy shows reasonable cost-effectiveness ratio, despite current evidence of limited benefit of this intervention.
authors.affiliation: Cardiology Division, Hospital de Clínicas de Porto Alegre, Department of Medicine and Graduate Program of Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Kühr
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Ribeiro
authors.forename: Luis Eduardo P
authors.initials: LE
authors.lastname: Rohde
authors.forename: Carisi A
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D001938:Brazil; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000191:economics*; D017048:Health Care Costs; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000503:physiopathology / Q000534:rehabilitation; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D009313:National Health Programs / Q000191:economics; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome