Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalization rate, medical costs and quality of life: A cost-effectiveness analysis.
BACKGROUND
Notwithstanding the cardiovascular disease epidemic, current budgetary constraints do not allow for budget expansion of conventional cardiac rehabilitation programmes. Consequently, there is an increasing need for cost-effectiveness studies of alternative strategies such as telerehabilitation. The present study evaluated the cost-effectiveness of a comprehensive cardiac telerehabilitation programme.


METHODS
This multi-centre randomized controlled trial comprised 140 cardiac rehabilitation patients, randomized (1:1) to a 24-week telerehabilitation programme in addition to conventional cardiac rehabilitation (intervention group) or to conventional cardiac rehabilitation alone (control group). The incremental cost-effectiveness ratio was calculated based on intervention and health care costs (incremental cost), and the differential incremental quality adjusted life years (QALYs) gained.


RESULTS
The total average cost per patient was significantly lower in the intervention group (€2156 ± €126) than in the control group (€2720 ± €276) (p = 0.01) with an overall incremental cost of €-564.40. Dividing this incremental cost by the baseline adjusted differential incremental QALYs (0.026 QALYs) yielded an incremental cost-effectiveness ratio of €-21,707/QALY. The number of days lost due to cardiovascular rehospitalizations in the intervention group (0.33 ± 0.15) was significantly lower than in the control group (0.79 ± 0.20) (p = 0.037).


CONCLUSIONS
This paper shows the addition of cardiac telerehabilitation to conventional centre-based cardiac rehabilitation to be more effective and efficient than centre-based cardiac rehabilitation alone. These results are useful for policy makers charged with deciding how limited health care resources should best be allocated in the era of exploding need.
Department of Cardiology, Jessa Hospital, Hasselt, Belgium Faculty of Medicine & Life Sciences, Hasselt University, Belgium ines.frederix@gmail.com.
Ines
I
Frederix
Faculty of Medicine & Life Sciences, Hasselt University, Belgium.
Dominique
D
Hansen
Faculty of Sciences, Expertise Centre for Digital Media, Hasselt University, Belgium.
Karin
K
Coninx
Faculty of Medicine & Life Sciences, Hasselt University, Belgium Department of Cardiology, Hospital East-Limburg, Genk, Belgium.
Pieter
P
Vandervoort
Faculty of Medicine & Life Sciences, Hasselt University, Belgium.
Dominique
D
Vandijck
Interuniversity Institute of Biostatistics and Statistical Bioinformatics, Hasselt University, Belgium Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Belgium.
Niel
N
Hens
Department of Cardiology, Antwerp University Hospital, Belgium.
Emeline
E
Van Craenenbroeck
Faculty of Medicine & Life Sciences, Hasselt University, Belgium.
Niels
N
Van Driessche
Department of Cardiology, Jessa Hospital, Hasselt, Belgium Faculty of Medicine & Life Sciences, Hasselt University, Belgium.
Paul
P
Dendale
D000368:Aged; D000072038:Cardiac Rehabilitation / Q000191:economics*; D002318:Cardiovascular Diseases / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000639:trends*; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012047:Rehabilitation Centers; D000069350:Telerehabilitation / Q000191:economics*; D013997:Time Factors
Telerehabilitation; cost-effectiveness; telecoaching; telemonitoring