Optimizing Value From Cardiac Rehabilitation: A Cost-Utility Analysis Comparing Age, Sex, and Clinical Subgroups.

Abstract

OBJECTIVE:

To assess the cost utility of a center-based outpatient cardiac rehabilitation program compared with no program within patient subgroups on the basis of age, sex, and clinical presentation (acute coronary syndrome [ACS] or non-ACS).

METHODS:

We performed a cost-utility analysis from a health system payer perspective to compare cardiac rehabilitation with no cardiac rehabilitation for patients who had a cardiac catheterization. The Markov 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 and TotalCardiology.

RESULTS:

The incremental cost per quality-adjusted life-year (QALY) gained for cardiac rehabilitation varies by subgroup, from $18,101 per QALY gained to $104,518 per QALY gained. There is 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 participation in cardiac rehabilitation is more expensive but more effective than not participating in cardiac rehabilitation.

CONCLUSION:

The cost-effectiveness of cardiac rehabilitation varies depending on patient characteristics. The current analysis indicates that cardiac rehabilitation is most cost effective for those with 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.

• Authors: Laura E Leggett, Trina Hauer, Billie-Jean Martin, Braden Manns, Sandeep Aggarwal, Ross Arena, Leslie D Austford, Don Meldrum, William Ghali, Merril L Knudtson, Colleen M Norris, James A Stone, Fiona Clement
• Journal: Mayo Clinic proceedings (Mayo Clin Proc) Vol. 90 Issue 8 Pg. 1011-20 (Aug 2015) ISSN: 1942-5546 [Electronic] England
• PMID: 26149321 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Topics

• Acute Coronary Syndrome (complications, mortality, therapy)
• Age Factors
• Aged
• Cardiac Catheterization
• Cohort Studies
• Cost-Benefit Analysis
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, mortality, therapy)
• Outcome Assessment, Health Care
• Quality-Adjusted Life Years
• Rehabilitation Centers (economics)
• Risk Factors
• Sex Factors