title: Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome.
abstract: Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n = 109) or usual care (UC) group (n = 95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -€24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.
authors.affiliation: Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hautala
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: A M
authors.initials: AM
authors.lastname: Kiviniemi
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Mäkikallio
authors.affiliation: Social and Health Services, City of Oulu, Oulu, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Koistinen
authors.affiliation: Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
authors.forename: O-P
authors.initials: OP
authors.lastname: Ryynänen
authors.affiliation: Pharmacoeconomics & Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: J A
authors.initials: JA
authors.lastname: Martikainen
authors.affiliation: Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Seppänen
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: H V
authors.initials: HV
authors.lastname: Huikuri
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: M P
authors.initials: MP
authors.lastname: Tulppo
mesh_terms: D054058:Acute Coronary Syndrome / Q000191:economics / Q000628:therapy*; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
keywords: Coronary heart disease; cost-effectiveness; exercise training; rehabilitation