title: Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care.
abstract: Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of cardiac rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac rehabilitation after heart valve surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of cardiac rehabilitation.
authors.affiliation: 1 Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.|2 National Institute of Public Health, University of Southern Denmark, Odense, Denmark.|3 The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Tina Birgitte
authors.initials: TB
authors.lastname: Hansen
authors.affiliation: 3 The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.|4 Danish Centre for Rehabilitation and Palliative Care, University of Southern Denmark and University Hospital of Odense, Odense, Denmark.
authors.forename: Ann Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.affiliation: 3 The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Selina Kikkenborg
authors.initials: SK
authors.lastname: Berg
authors.affiliation: 3 The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Kirstine Lærum
authors.initials: KL
authors.lastname: Sibilitz
authors.affiliation: 2 National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Lau Caspar
authors.initials: LC
authors.lastname: Thygesen
authors.affiliation: 5 National Institute for Regional and Local Government Research, Copenhagen, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Kjellberg
authors.affiliation: 6 Department of Health Sciences, University of York, York, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Doherty
authors.affiliation: 7 College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Oldridge
authors.affiliation: 8 Department of Public Health, Aarhus University, Aarhus, Denmark.|9 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Søgaard
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D003718:Denmark; D005081:Exercise Therapy / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000534:rehabilitation* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000379:methods; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac rehabilitation; cost–utility; economic evaluation; heart valve surgery