Abstract
ObjectivePeripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD) undergoing cardiac rehabilitation.Data SourcesBest-available evidence was retrieved from literature and combined with primary data from 231 patients.MethodsWe developed a Markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI) if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs), life-time costs (US $), incremental cost-effectiveness ratios (ICER), and gain in net health benefits (NHB) in QALY equivalents were calculated. A threshold willingness-to-pay of $75 000 was used.ResultsABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44 251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: −0.17, 0.29) at a threshold willingness-to-pay of $75 000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30 246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:−0.24, 0.46) compared to current practice. The results were robust for other different input parameters.ConclusionABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.
Highlights
Coronary artery disease (CAD) is the leading cause of mortality and morbidity in the United States[1]
ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for peripheral arterial disease (PAD) if needed are potentially cost-effective compared to cardiac rehabilitation only
This assumption was based on an 80% success rate as a result of the vascular component of the combined rehabilitation program in patients who would otherwise fail due to PAD
Summary
Coronary artery disease (CAD) is the leading cause of mortality and morbidity in the United States[1]. Millions of Americans have a history of myocardial infarction or experience angina pectoris[1]. Many of these patients (on average 300 000 per year) enter a rehabilitation program and those who have undergone revascularization procedures undergo cardiac rehabilitation with the objective of improving exercise tolerance, symptoms, serum lipid levels, and psychosocial well-being, while reducing cardiac risk factors and mortality[2,3]. Patients with CAD, frequently have peripheral arterial disease (PAD)(range 19%–42%)[5,6], of whom approximately 50% are symptomatic [5]. Measurement of the ankle-brachial-index (ABI) at rest and post exercise is recommended as the initial screening test to make the diagnosis of PAD and using this to decide whether patients need a workup for PAD either if rehabilitation fails or prior to the rehabilitation program to improve the results of the program
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call