Cost-effectiveness of cardiac rehabilitation: a systematic review

Abstract

Patients may be offered cardiac rehabilitation (CR), a supervised programme often including exercises, education and psychological care, following a cardiac event, with the aim of reducing morbidity and mortality. Cost-constrained healthcare systems require information about the best use of budget and resources to maximise patient benefit. We aimed to systematically review and critically appraise economic studies of CR and its components. In January 2016, validated electronic searches of the National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment, PsycINFO, MEDLINE and Embase databases were run to identify full economic evaluations published since 2001. Two levels of screening were used and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed using the NHS EED handbook and Drummond checklist. The majority of studies concluded that CR was cost-effective versus no CR (incremental cost-effectiveness ratios (ICERs) ranged from $1065 to $71 755 per quality-adjusted life-year (QALY)). Evidence for specific interventions within CR was varied; psychological intervention ranged from dominant (cost saving and more effective) to $226 128 per QALY, telehealth ranged from dominant to $588 734 per QALY and while exercise was cost-effective across all relevant studies, results were subject to uncertainty. Key drivers of cost-effectiveness were risk of subsequent events and hospitalisation, hospitalisation and intervention costs, and utilities. This systematic review of studies evaluates the cost-effectiveness of CR in the modern era, providing a fresh evidence base for policy-makers. Evidence suggests that CR is cost-effective, especially with exercise as a component. However, research is needed to determine the most cost-effective design of CR.

Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017

“…Similarly, global health policies are, now, more inclusive of people with disabilities and their rehabilitation needs [87,102,103]. Finally, the evidence of cost-effectiveness of rehabilitation is escalating [104,105]. In this context, our finding that Agestandardized YLDs were significantly reduced in high-income countries, but not in LMICs, can be another indicator of the need to scale up rehabilitation services in LMIC's health systems [24].…”

“…adding "AND "Cochrane Database Syst Rev"[Journal]" to the search approach). As an example, we found that the quantity, quality and strength of the evidence base for cardiac rehabilitation varies across various cardiac conditions [36][37][38][39][40][41][42], but strong evidence that cardiac rehabilitation approaches are overall costeffective [44]. Thus, we included YLDs from all cardiovascular conditions as being amenable to physical rehabilitation.…”

Advances in rehabilitation for chronic diseases: improving health outcomes and function

“…Much of the research has focused on the exercise component of cardiac rehabilitation, with a meta-analysis showing that people who participate in a program increase their structured exercise significantly more than those who do not participate,32 and that such interventions are cost effective 31. A 2013 international consensus statement that focused on recommendations for choice of workload intensity in cardiac rehabilitation generally favored higher intensity over light to moderate intensity workloads to maximize benefit 33.…”

Participants’ Perspectives of a Primary Exercise-Based Prevention Program for Cardiac Patients: A Prepost Intervention Qualitative Case Study

“…Participation in exercise-based, cardiac-rehabilitation programs and the adoption of healthy life habits are known to significantly diminish the negative consequences of cardiovascular disease [5]. The efficacy and cost-benefit ratio of exercise programs for primary and secondary prevention in people with heart diseases or those with risk factors for the development of these diseases are well documented in the literature and show that cardiac rehabilitation is costeffective [6,7,8]. Regular physical activity provides many health benefits to these patients such as reduced hospital readmission [9], ability to perform activities of daily living, quality of life, risk factor profile, and exercise capacity [6].…”