Abstract
BackgroundPhysical activity programs (PAP) in patients with cardiovascular disease require evidence of cost-utility. To assess improvement in health-related quality of life (QoL) and reduction of health care consumption of patients following PAP, a randomized trial was used.MethodsPatients from a health insurance company who had experienced coronary artery disease or moderate heart failure were invited to participate (N = 1891). Positive responders (N = 50) were randomly assigned to a progressively autonomous physical activity (PAPA) program or to a standard supervised physical activity (SPA) program. The SPA group had two supervised sessions per week over 5 months. PAPA group had one session per week and support to aid habit formation (written tips, exercise program, phone call). To measure health-related quality of life EQ-5D utility score were used, before intervention, 6 months (T6) and 1 year later. Health care costs were provided from reimbursement databases.ResultsMobility, usual activities and discomfort improved significantly in both group (T6). One year later, EQ-5D utility score was improved in the PAPA group only. Total health care consumption in the intervention group decreased, from a mean of 4097 euros per year before intervention to 2877 euros per year after (p = 0.05), compared to a health care consumption of 4087 euros and 4180 euros per year, in the total population of patients (N = 1891) from the health insurance company. The incremental cost effectiveness ratio was 10,928 euros per QALYs.ConclusionA physical activity program is cost-effective in providing a better quality of life and reducing health care consumption in cardiovascular patients.Trial registrationISRCTN77313697, retrospectively registered on 20 November 2015.
Highlights
Physical activity programs (PAP) in patients with cardiovascular disease require evidence of costutility
There was no significant difference of age, sex ratio, body mass index, or European Quality in 5 Dimensions (EQ-5D) utility score between progressively autonomous physical activity (PAPA) patients and supervised physical activity (SPA) patients
Compared to the studies using the six-minute walk test as a prognostic factor [20, 22, 23], at baseline our participants walked a distance corresponding to the highest quartile, similar to those observed in a French population of patients [25] at the end of a cardiac rehabilitation program after an acute coronary syndrome, i.e. 510 to 620 m
Summary
Physical activity programs (PAP) in patients with cardiovascular disease require evidence of costutility. Physical activity in patients with cardiovascular disease has been shown to improve exercise capacity and health-related quality of life and to reduce hospital admissions [2]. The aim is to promote the adoption and maintenance [3] of healthful behaviors in cardiovascular patients, notably by supervised physical activity (PA) programs. Many of those patients do not maintain regular physical activity [4, 5] after program completion. The first objective of the “As du Coeur study” was to compare the two interventions on physical activity maintenance [9]. The second objective was to establish the cost effectiveness of the program
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