The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review

Abstract

INTRODUCTION Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets lead to cost-effectiveness analyses before implementation. They are appropriate in cases where there is evidence that the compared intervention provides a similar health benefit to usual care. This systematic review aimed to compare the cost-effectiveness of exercise-based telehealth CR interventions compared to standard exercise-based CR. EVIDENCE ACQUISITION PubMed and Web of Science databases were systematically searched up to August 2022 to identify randomized controlled trials assessing patients undergoing telehealth CR. The intervention was compared to standard CR protocols. The primary intent was to identify the cost-effectiveness. Interventions that met the criteria were home-based telehealth CR interventions delivered by information and communications technology (telephone, computer, internet, or videoconferencing) and included the results of an economic evaluation, comparing interventions in terms of cost-effectiveness, utility, costs and benefits, or cost-minimization analysis. The systematic review protocol was registered in the PROSPERO Registry (CRD42022322531). EVIDENCE SYNTHESIS Out of 1525 identified studies, 67 articles were assessed for eligibility, and, at the end of the screening process, 12 studies were included in the present systematic review. Most studies (92%) included in this systematic review found strong evidence that exercise-based telehealth CR is cost-effective. Compared to CBCR, there were no major differences, except for three studies evaluating a significant difference in average cost per patient and intervention costs in favor of telehealth CR. CONCLUSIONS Telehealth CR based on exercise is as cost-effective as CBCR interventions. Funding telehealth CR by third-party payers may promote patient participation to increase overall CR utilization. High-quality research is needed to identify the most cost-effective design.

Home-based model is an important cost-effective alternative to centre-based cardiac rehabilitation

“…Narratively synthesised results favoured home-based care delivered through a telerehabilitation approach, except one used a user manual. This study further confirms the finding by Batalik and colleagues, affirming the cost-effectiveness of exercise-based cardiac telerehabilitation intervention 4. Using a systematic comparison, the costs of providing intervention, unplanned healthcare services usage and incremental cost-effectiveness ratio all favoured home-based CR 4.…”

Tele-Assessment of Functional Capacity through the Six-Minute Walk Test in Patients with Diabetes Mellitus Type 2: Validity and Reliability of Repeated Measurements

“…The 6MWT is a suitable tool for assessing functional capacity in diabetic patients due to its good acceptability and its easy incorporation into daily living activities; thus appearing as the best among the current walking tests [ 8 ]. A large number of studies have reported the necessity and utility of telehealth through various applications for patients with DM2, including telelearning, telemonitoring, DM self-management, and telecounseling [ 21 , 24 , 41 , 42 ]. Telemedicine studies, such as the research by Milani [ 23 ], have shown that telehealth applications can increase glycemic control, reduce glycated hemoglobin values, and improve the quality of life [ 43 , 44 , 45 ].…”

“…Thus, telehealth could represent a valuable method to improve blood sugar control, prevent rehospitalization, enhance the quality of life, and improve adherence rates to therapeutic interventions in patients with DM2 [ 21 , 22 , 23 ]. Telehealth services also reduce costs and increase the potential to attend more sessions compared to center-based facilities [ 24 ]. Specifically, the COVID-19 pandemic dramatically increased the application of telehealth and the need for reliable remote monitoring of chronic patients [ 25 ].…”

Rehabilitation Is the Main Topic in Virtual and Augmented Reality and Physical Activity Research: A Bibliometric Analysis

“…Moreover, they are becoming essential tools in Biomedicine and Bioengineering because of their ability to provide accurate, interactive, and immersive simulations of biological systems [ 88 ]. Thus, these technologies make it possible to deliver home-based assessments and interventions or telehealth, potentially offering cost-effective alternatives in several areas [ 59 , 89 ]. Furthermore, multiple practical applications are also emerging in sports sciences to increase the population’s PA levels through exergames, performance enhancement programs with technical or tactical training applications, and sports injuries recovery.…”