Exercise-based cardiac rehabilitation after heart valve surgery: cost analysis of healthcare use and sick leave

Abstract

BackgroundOwing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR on the costs of healthcare use and sick leave among heart valve surgery patients over 12 months post surgery.MethodsWe conducted a nationwide survey on the CR participation of all patients having undergone valve surgery between 1 January 2011 and 30 June 2011 (n=667). Among the responders (n=500, 75%), the resource use categories of primary and secondary healthcare, prescription medication and sick leave were analysed for CR participants (n=277) and non-participants (n=223) over 12 months. A difference-in-difference analysis was undertaken. All estimates were presented as the means per patient (95% CI) based on non-parametric bootstrapping of SEs.ResultsTotal costs during the 12 months following surgery were €16 065 per patient (95% CI 13 730 to 18 399) in the CR group and €15 182 (12 695 to 17 670) in the non-CR group. CR led to 5.6 (2.9 to 8.3, p<0.01) more outpatient visits per patient. No statistically significant differences in other cost categories or total costs €1330 (−4427 to 7086, p=0.65) were found between the groups.ConclusionsCR, as provided in Denmark, can be considered cost neutral. CR is associated with more outpatient visits, but CR participation potentially offsets more expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis.

Cost–utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

“…10 According to current guidelines, all patients received a physical examination and biochemical and echocardiographic assessment from the referral hospital following surgery. 11 Costs and outcomes were evaluated from the date of discharge and until 6 months post-surgery, which was considered an adequate length of follow-up, since costs are mainly incurred within the first months post-surgery, 8 and mortality rates are considered low following surgery. 4,5…”

“…A recent Danish nationwide survey of patients undergoing heart valve surgery demonstrated no significant differences in total costs or other categories of primary care visits, inpatient hospital admissions, prescription medication or sick leave costs, and concluded that CR, when compared to non-participation, can be considered cost-neutral and may even offset more expensive outpatient visits. 8 However, the study contained no information on HRQL or other patient-reported outcomes, which are crucial to informing health policy planning regarding the attractiveness of CR as a routine practice. Within the field of CR, cost–utility analyses are particularly warranted.…”

Employment status before and after open heart valve surgery: A cohort study

“…Earlier studies have focused on different aspects of return to the workforce following open heart valve surgery: work status before surgery and participation in cardiac rehabilitation and the likelihood of returning to the workforce [1,12]. Thus, to our knowledge, this is the first study to investigate clinical characteristics and the association with return to the workforce.…”

“…Similarly, to prevent detachment from the workforce to the extent possible, a better understanding of the associated factors is warranted. Currently, research investigating interventions aiming at increasing the likelihood of returning to the workforce is sparse with current studies lacking statistical power or reporting conflicting results [12,24].…”

“…Knowledge of specific factors associated with return to the workforce after open heart valve surgery is sparse: Unemployment one year before surgery has been associated with reduced likelihood of returning to the workforce [1], whereas participating in cardiac rehabilitation is not associated with returning to the workforce [12]. Some studies have investigated factors associated with the likelihood of returning to the workforce following coronary artery bypass grafting (CABG) and demonstrated how younger age, male sex, higher educational level, work status before surgery and higher income were associated with returning to the workforce [1,13,14].…”