title: Economic evaluation of exercise training in patients with pulmonary hypertension.
abstract: OBJECTIVE
  Exercise training as an add-on to medical therapy has been shown to improve exercise capacity, quality of life, and possibly prognosis in patients with pulmonary hypertension (PH). The purpose of this study was to analyze the impact of exercise training on healthcare costs in PH.
  
  
  METHODS
  Estimated healthcare costs have been compared between patients with severe PH under optimized medical therapy only (control group) versus patients who received exercise training as an add-on to medical therapy (training group). Cost-analysis included a cost-estimation model of costs for baseline and follow-up visits and all PH-related healthcare events that occurred within the follow-up period. Time to clinical worsening and survival were assessed by clinical records, phone, and/or control visits.
  
  
  RESULTS
  At baseline, the training (n = 58) and control group (n = 48) did not differ in age, gender, WHO-functional class, 6-min walking distance, hemodynamic parameters, or PH-targeted medication. During a follow-up of 24 ± 12 months, the training group had significantly better survival rates at 1 and 3 years and less worsening events (death, lung transplantation, hospitalization due to PH, new PAH-targeted medication) than the control group (15 vs. 25 events, p < 0.05), which also led to lower estimated healthcare costs of 657<euro> within a period of 2 years.
  
  
  CONCLUSIONS
  This is the first study to investigate the cost-effectiveness of exercise training in PH. Due to less worsening events within 2 years, healthcare costs were lower in patients performing exercise training as add-on to medical therapy than in patients with medical treatment only. Further prospective, randomized studies are needed to confirm these findings.
authors.affiliation: Department of Pneumology, Thoraxclinic Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany, nicola.ehlken@med.uni-heidelberg.de.
authors.forename: Nicola
authors.initials: N
authors.lastname: Ehlken
authors.forename: Cora
authors.initials: C
authors.lastname: Verduyn
authors.forename: Henning
authors.initials: H
authors.lastname: Tiede
authors.forename: Gerd
authors.initials: G
authors.lastname: Staehler
authors.forename: Gabriele
authors.initials: G
authors.lastname: Karger
authors.forename: Robert
authors.initials: R
authors.lastname: Nechwatal
authors.forename: Christian F
authors.initials: CF
authors.lastname: Opitz
authors.forename: Hans
authors.initials: H
authors.lastname: Klose
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
authors.forename: Stephan
authors.initials: S
authors.lastname: Rosenkranz
authors.forename: Michael
authors.initials: M
authors.lastname: Halank
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Grünig
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005081:Exercise Therapy / Q000191:economics*; D017079:Exercise Tolerance; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome