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

Background: Cardiac rehabilitation reduces mortality and subsequent cardiac events in patients with coronary heart disease. While economic evaluations of cardiac rehabilitation have been published, none consider clinical, age and sex subgroups to demonstrate how the cost-effectiveness varies. Methods: We performed a cost-utility analysis comparing cardiac rehabilitation with no cardiac rehabilitation, for patients who had a cardiac catheterization, using a health system payer perspective. The 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 (APPROACH) and TotalCardiology. Data on efficacy was obtained from a meta-analysis of randomized controlled trials. Results: The incremental cost per quality-adjusted life year (QALY) gained for cardiac rehabilitation is $37,662. The incremental cost per QALY gained varies by subgroup, from $18,101 per QALY gained to $104,518 per QALY gained. There is significant 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, cardiac rehabilitation is more effective and expensive than no cardiac rehabilitation. Conclusions: The cost-effectiveness of cardiac rehabilitation varies depending on patient characteristics. However, irrespective of baseline characteristics, the cost per QALY gained for cardiac rehabilitation is less than or similar to other technologies funded in many health systems. The current analysis indicates that cardiac rehabilitation is most cost effective for those who suffered 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.

Name thesis:degree_name

Master of Science (MSc)

Discipline thesis:degree_discipline

Community Health Sciences

Grantor dc:publisher.institution

Graduate Studies

Year dc:date.issued

2014

Author dc:creator

• Leggett, Laura

Advisor dc:contributor.advisor

• Clement, Fiona

• Health Sciences

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

eng

DOI

http://dx.doi.org/10.11575/PRISM/27217

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:11023/1549