title: Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes: Findings from the COPE-ICD randomized controlled trial.
abstract: OBJECTIVE
  The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs.
  
  
  METHODS
  Patients with first-time implantable cardioverter defibrillator implantation (n = 196) were randomized (1:1) to comprehensive cardiac rehabilitation or usual care. Outcomes were measured by implantable cardioverter defibrillator therapy history from patient records and national register follow-up on mortality, hospital admissions and costs.
  
  
  RESULTS
  No significant differences were found after 3 years for implantable cardioverter defibrillator therapy or mortality between rehabilitation and usual care. Time to first admission did not differ. The cost of rehabilitation was 335 USD/276 Euro per patient enrolled in rehabilitation. The total attributable cost of rehabilitation after 3 years was -6,789 USD/-5,593 Euro in favour of rehabilitation.
  
  
  CONCLUSIONS
  No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs.
authors.affiliation: The Heart Centre, Rigshospitalet, 2100 Copenhagen, Denmark. Selina.Kikkenborg.Berg.01@regionh.dk, selina@rh.dk.
authors.forename: Selina Kikkenborg
authors.initials: SK
authors.lastname: Berg
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.forename: Mette Bjerrum
authors.initials: MB
authors.lastname: Koch
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.forename: Anne Vinggaard
authors.initials: AV
authors.lastname: Christensen
authors.forename: Preben U
authors.initials: PU
authors.lastname: Pedersen
authors.forename: Lau Caspar
authors.initials: LC
authors.lastname: Thygesen
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000191:economics / Q000534:rehabilitation* / Q000628:therapy; D017147:Defibrillators, Implantable; D003718:Denmark; D005081:Exercise Therapy / Q000191:economics / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult