Economic evaluation of cardiac rehabilitation: a systematic review.
Papadakis, Sophia a b; Oldridge, Neil B. c; Coyle, Doug d; Mayhew, Alain e; Reid, Robert D. a; Beaton, Louise a; Dafoe, William A. f; Angus, Doug b
European Journal of Cardiovascular Prevention & Rehabilitation.
12(6):513-520, December 2005.
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Background: Economic evaluation is an important tool in the evaluation of competing healthcare interventions. Little is known about the economic benefits of different cardiac rehabilitation program delivery models.
Design: The goal of this study was to review and evaluate the methodological quality of published economic evaluations of cardiac rehabilitation services.
Methods: Electronic databases were searched for English language evaluations (trials, modeling studies) of the economic impact of cardiac rehabilitation. A review of study characteristics and methodological quality was completed using standardized tools. All costs are adjusted to 2004 US dollars.
Results: Fifteen economic evaluations were identified which met eligibility criteria but which displayed wide variation in the use of comparators, evaluation type, perspective and design. Evidence to support the cost-effectiveness of supervised cardiac rehabilitation in myocardial infarction and heart failure patients was identified. The range of cost per life year gained was estimated as from $2193 to $28 193 and from -$668 to $16 118 per quality adjusted life year gained. The level of evidence supporting the economic value of home-based cardiac rehabilitation interventions is limited to partial economic analyses.
Conclusions: Evidence to support the cost-effectiveness of supervised cardiac rehabilitation compared with usual care in myocardial infarction and heart failure was identified. Further trials are required to support the cost-effectiveness of cardiac rehabilitation in cardiac patients who have under gone revascularization. The literature evaluating home-based and alternative delivery models of cardiac rehabilitation was insufficient to draw conclusions about their relative cost-effectiveness. The overall quality of published economic evaluations of cardiac rehabilitation is poor and further well-designed trials are required.
(C) 2005 European Society of Cardiology