title: Optimizing Value From Cardiac Rehabilitation: A Cost-Utility Analysis Comparing Age, Sex, and Clinical Subgroups.
abstract: OBJECTIVE
  To assess the cost utility of a center-based outpatient cardiac rehabilitation program compared with no program within patient subgroups on the basis of age, sex, and clinical presentation (acute coronary syndrome [ACS] or non-ACS).
  
  
  METHODS
  We performed a cost-utility analysis from a health system payer perspective to compare cardiac rehabilitation with no cardiac rehabilitation for patients who had a cardiac catheterization. The Markov model was stratified by clinical presentation, age, and sex. Clinical, quality-of-life, and cost data were provided by the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease and TotalCardiology.
  
  
  RESULTS
  The incremental cost per quality-adjusted life-year (QALY) gained for cardiac rehabilitation varies by subgroup, from $18,101 per QALY gained to $104,518 per QALY gained. There is uncertainty in the estimates due to uncertainty in the clinical effectiveness of cardiac rehabilitation. Overall, the probabilistic sensitivity analysis found that 75% of the time participation in cardiac rehabilitation is more expensive but more effective than not participating in cardiac rehabilitation.
  
  
  CONCLUSIONS
  The cost-effectiveness of cardiac rehabilitation varies depending on patient characteristics. The current analysis indicates that cardiac rehabilitation is most cost effective for those with an ACS and those who are at higher risk for subsequent cardiac events. The findings of the current study provide insight into who may benefit most from cardiac rehabilitation, with important implications for patient referral patterns.
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Leggett
authors.affiliation: TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada.
authors.forename: Trina
authors.initials: T
authors.lastname: Hauer
authors.affiliation: Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: Billie-Jean
authors.initials: BJ
authors.lastname: Martin
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.affiliation: TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada; Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois, Chicago.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada.
authors.forename: Leslie D
authors.initials: LD
authors.lastname: Austford
authors.affiliation: TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: Don
authors.initials: D
authors.lastname: Meldrum
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Ghali
authors.affiliation: Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiac Surgery, Mazankowsky Alberta Heart Institute, Edmonton, Alberta, Canada.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.affiliation: TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Stone
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada. Electronic address: fclement@ucalgary.ca.
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy; D000367:Age Factors; D000368:Aged; D006328:Cardiac Catheterization; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012047:Rehabilitation Centers / Q000191:economics*; D012307:Risk Factors; D012737:Sex Factors