title: Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial.
abstract: BACKGROUND
  Learning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitation programme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure.
  
  
  METHODS
  The study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standard rehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical training and education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal cost perspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjusted life years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preference weights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped standard errors.
  
  
  RESULTS
  An additional cost of DKK 6,043 (95% CI -5,697; 17,783) and a QALY gain of 0.005 (95% CI -0.001; 0.012) was estimated for LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention. The probability that LC would be cost-effective did not exceed 29% for any threshold values of willingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62% over the threshold values.
  
  
  CONCLUSIONS
  The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-up should be evaluated before a definite conclusion is drawn.
  
  
  CONCLUSIONS
  Future research should assess the LC strategies' long-term efficacy and cost-utility.
  
  
  BACKGROUND
  NCT01668394.
authors.affiliation: Health Economics, Public Health and Quality Improvement, Olof Palmes Alle 15, 8200, Aarhus N, Denmark. nastay@rm.dk.|Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark. nastay@rm.dk.
authors.forename: Nasrin Tayyari
authors.initials: NT
authors.lastname: Dehbarez
authors.affiliation: Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark. viblyn@rm.dk.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Lynggaard
authors.affiliation: Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark. ole.may@vest.rm.dk.
authors.forename: Ole
authors.initials: O
authors.lastname: May
authors.affiliation: Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark. ra@ph.au.dk.|Department of Clinical Medicine, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark. ra@ph.au.dk.
authors.forename: Rikke
authors.initials: R
authors.lastname: Søgaard
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D003362:Cost-Benefit Analysis; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years