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Review
. 2019 Jun 4:2019:1840894.
doi: 10.1155/2019/1840894. eCollection 2019.

Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis

Tomoyuki Takura  1 , Nozomi Ebata-Kogure  2 , Yoichi Goto  3 , Masahiro Kohzuki  4 , Masatoshi Nagayama  5 , Keiko Oikawa  6 , Teruyuki Koyama  7 , Haruki Itoh  5
Affiliations
Review

Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis

Tomoyuki Takura et al. Cardiol Res Pract. .

Abstract

Background: Medical costs associated with cardiovascular disease are increasing considerably worldwide; therefore, an efficacious, cost-effective therapy which allows the effective use of medical resources is vital. There have been few economic evaluations of cardiac rehabilitation (CR), especially meta-analyses of medical cost versus patient outcome.

Methods: The target population in this meta-analysis included convalescent and comprehensive CR patients with coronary artery disease (CAD), the status most commonly observed postmyocardial infarction (MI). Here, we evaluated medical costs, quality-adjusted life year (QALY), cost-effectiveness, mortality, and life year (LY). Regarding cost-effectiveness analysis, we analyzed medical costs per QALY, medical costs per LY, and the incremental cost-utility ratio (ICUR). We then examined the differences in effects for the 2 treatment arms (CR vs. usual care (UC)) using the risk ratio (RR) and standardized mean difference (SMD).

Results: We reviewed 59 studies and identified 5 studies that matched our selection criteria. In total, 122,485 patients were included in the analysis. Meta-analysis results revealed that the CR arm significantly improved QALY (SMD: -1.78; 95% confidence interval (CI): -2.69, -0.87) compared with UC. Although medical costs tended to be higher in the CR arm compared to the UC arm (SMD: 0.02; 95% CI: -0.08, 0.13), cost/QALY was significantly improved in the CR arm compared with the UC arm (SMD: -0.31; 95% CI: -0.53, -0.09). The ICURs for the studies (4 RCTs and 1 model analysis) were as follows: -48,327.6 USD/QALY; -5,193.8 USD/QALY (dominant, CR is cheaper and more effective than UC); and 4,048.0 USD/QALY, 17,209.4 USD/QALY, and 26,888.7 USD/QALY (<50,000 USD/QALY, CR is costlier but more effective than UC), respectively. Therefore, there were 2 dominant and 3 effective results.

Conclusions: While there are some limitations, primarily regarding data sources, our results suggest that CR is potentially cost-effective.

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Figures

Figure 1
Figure 1
Example of the cost-effectiveness plane. Source: T. Takura, “Creating new value in medical care—methodology of social evaluation of medical technologies,” Iyaku Keizai, vol. 1339, pp. 16–17, 2009.
Figure 2
Figure 2
PRISMA 2009 flow diagram.
Figure 3
Figure 3
Comparison of cost, efficacy, and mortality between the cardiac rehabilitation (CR) arm and the usual care (UC) arm in patients with myocardial infarction (MI): meta-analysis. (a) Cost and efficacy, (b) cost and efficacy without the study by Leggett et al., and (c) mortality.
Figure 4
Figure 4
Comparison of cost-utility between the cardiac rehabilitation (CR) arm and the usual care (UC) arm in patients with myocardial infarction (MI): meta-analysis. (a) Cost-utility and (b) cost-utility without the study by Leggett et al.
See this image and copyright information in PMC

References

    1. Takura T. Background and current trends in medical economics research in the circulatory field—what to expect in circulation reports. Circulation Reports. 2018:11–14. - PMC - PubMed
    1. Balady G. J., Williams M. A., Ades P. A., et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the american heart association exercise, cardiac rehabilitation, and prevention committee, the council on clinical cardiology; the councils on cardiovascular nursing, epidemiology and prevention, and nutrition, physical activity, and metabolism; and the american association of cardiovascular and pulmonary rehabilitation. Circulation. 2007;115(20):2675–2682. doi: 10.1161/circulationaha.106.180945. - DOI - PubMed
    1. Piepoli M. F., Corrà U., Benzer W., et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the cardiac rehabilitation section of the European association of cardiovascular prevention and rehabilitation. European Journal of Cardiovascular Prevention & Rehabilitation. 2010;17(1):1–17. doi: 10.1097/hjr.0b013e3283313592. - DOI - PubMed
    1. Taylor R. S., Brown A., Ebrahim S., et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. American Journal of Medicine. 2004;116(10):682–692. doi: 10.1016/j.amjmed.2004.01.009. - DOI - PubMed
    1. Lawler P. R., Filion K. B., Eisenberg M. J. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. American Heart Journal. 2011;162(4):571–584.e2. doi: 10.1016/j.ahj.2011.07.017. - DOI - PubMed

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