title: Cardiac rehabilitation in low- and middle-income countries: a review on cost and cost-effectiveness.
abstract: BACKGROUND
  By 2030, more than 80% of cardiovascular disease-related deaths and disability-adjusted life years will occur in the 139 low- and middle-income (LMIC) countries. Cardiac rehabilitation (CR) has been demonstrated to be effective and cost-effective mainly based on data from high-income countries. The purpose of this paper was to review the literature for cost and cost-effectiveness data on CR in LMICs.
  
  
  METHODS
  MEDLINE (Ovid) and EMBASE (Ovid) electronic databases were searched for CR 'cost' and 'cost-effectiveness' data in LMICs.
  
  
  RESULTS
  Five CR publications with cost and cost-effectiveness data from middle-income countries were identified with none from low-income countries. Studies from Brazil demonstrated mean monthly savings of US$190 for CR, with a US$48 increase in a control group with mean costs of US$503 for a 3-month CR program. Mean costs to the public health care system of US$360 and US$540 when paid out-of-pocket were reported for a 3-month CR program in seven Latin American middle-income countries. Cardiac rehabilitation is reported to be cost-effective in both Brazil and Colombia.
  
  
  CONCLUSIONS
  Cardiac rehabilitation for patients with heart failure in Brazil and Colombia was estimated to be cost-effective. However, given the limited health care budgets in many LMICs, affordable CR models will need to be developed for LMICs, particularly for low-income countries.
authors.affiliation: College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA neilb@uwm.edu.
authors.forename: Neil B
authors.initials: NB
authors.lastname: Oldridge
authors.affiliation: Library & Information Services, UHN Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Pakosh
authors.affiliation: Cardiovascular Health Clinic, Mayo Clinic and Foundation Rochester, Minnesota, USA.
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
mesh_terms: D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000191:economics*; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D006801:Humans
keywords: Cardiac rehabilitation; Cardiovascular disease; Cost; Cost-effectiveness; Low-income country; Middle-income country