Laura E Leggett1, Trina Hauer2, Billie-Jean Martin3, Braden Manns4, Sandeep Aggarwal5, Ross Arena6, Leslie D Austford2, Don Meldrum5, William Ghali4, Merril L Knudtson3, Colleen M Norris7, James A Stone5, Fiona Clement8. 1. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada. 2. TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada. 3. Libin Cardiovascular Institute, Calgary, Alberta, Canada. 4. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada. 5. TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada. 6. TotalCardiology Rehabilitation and Risk Reduction (Formerly Cardiac Wellness Institute of Calgary), Calgary, Alberta, Canada; Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois, Chicago. 7. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiac Surgery, Mazankowsky Alberta Heart Institute, Edmonton, Alberta, Canada. 8. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Calgary, Alberta, Canada. Electronic address: fclement@ucalgary.ca.
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.
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: Daniel E Forman; Ross Arena; Rebecca Boxer; Mary A Dolansky; Janice J Eng; Jerome L Fleg; Mark Haykowsky; Arshad Jahangir; Leonard A Kaminsky; Dalane W Kitzman; Eldrin F Lewis; Jonathan Myers; Gordon R Reeves; Win-Kuang Shen Journal: Circulation Date: 2017-03-23 Impact factor: 29.690
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Authors: Danielle A Southern; Matthew T James; Stephen B Wilton; Lawrence DeKoning; Hude Quan; Merril L Knudtson; William A Ghali Journal: Int J Popul Data Sci Date: 2018-11-12