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

Tomoyuki Takura,Keiko Oikawa,Yoichi Goto,Masatoshi Nagayama,Nozomi Ebata-Kogure,Masahiro Kohzuki,Haruki Itoh,Teruyuki Koyama

doi:10.1155/2019/1840894

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.

Highlights

Healthcare resources are growing increasingly sparse in advanced nations due to declining birth rates, aging populations, and weakening of the underlying economic foundations
After reviewing the studies in the 6 systematic reviews, we identified 4 randomized controlled trials (RCTs) [13,14,15, 18, 28] and 1 model analysis to be included in the meta-analysis (Figure 2)
We could not calculate life year (LY), cost/LY, or mortality from this model analysis, we included this cohort in our meta-analysis of medical costs, quality-adjusted life year (QALY), and cost/QALY

Summary

Background

Medical costs associated with cardiovascular disease are increasing considerably worldwide; an efficacious, cost-effective therapy which allows the effective use of medical resources is vital. ere have been few economic evaluations of cardiac rehabilitation (CR), especially meta-analyses of medical cost versus patient outcome. Ere have been few economic evaluations of cardiac rehabilitation (CR), especially meta-analyses of medical cost versus patient outcome. E 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). Regarding cost-effectiveness analysis, we analyzed medical costs per QALY, medical costs per LY, and the incremental cost-utility ratio (ICUR). 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. 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). While there are some limitations, primarily regarding data sources, our results suggest that CR is potentially cost-effective

Introduction

Methods

Results

Conflicts of Interest