Optimizing Value from Cardiac Rehabilitation: A Cost-Utility Analysis Comparing Age, Sex and Clinical Subgroups
Date
2014-05-23
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Abstract
Background: Cardiac rehabilitation reduces mortality and subsequent cardiac events in patients with coronary heart disease. While economic evaluations of cardiac rehabilitation have been published, none consider clinical, age and sex subgroups to demonstrate how the cost-effectiveness varies.
Methods: We performed a cost-utility analysis comparing cardiac rehabilitation with no cardiac rehabilitation, for patients who had a cardiac catheterization, using a health system payer perspective. The model was stratified by clinical presentation, age and sex. Clinical, quality of life and cost data were provided by the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) and TotalCardiology. Data on efficacy was obtained from a meta-analysis of randomized controlled trials.
Results: The incremental cost per quality-adjusted life year (QALY) gained for cardiac rehabilitation is $37,662. The incremental cost per QALY gained varies by subgroup, from $18,101 per QALY gained to $104,518 per QALY gained. There is significant uncertainty in the estimates due to uncertainty in the clinical effectiveness of cardiac rehabilitation. Overall, the probabilistic sensitivity analysis found that 75% of the time, cardiac rehabilitation is more effective and expensive than no cardiac rehabilitation.
Conclusions: The cost-effectiveness of cardiac rehabilitation varies depending on patient characteristics. However, irrespective of baseline characteristics, the cost per QALY gained for cardiac rehabilitation is less than or similar to other technologies funded in many health systems. The current analysis indicates that cardiac rehabilitation is most cost effective for those who suffered an ACS and those who are at higher risk for subsequent cardiac events. The findings of the current study provide insight into who may benefit most from cardiac rehabilitation, with important implications for patient referral patterns.
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Citation
Leggett, L. (2014). Optimizing Value from Cardiac Rehabilitation: A Cost-Utility Analysis Comparing Age, Sex and Clinical Subgroups (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/27217