Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis. (4th June 2019)

• Record Type: Journal Article
• Authors: Takura, Tomoyuki; Ebata-Kogure, Nozomi; Goto, Yoichi; Kohzuki, Masahiro; Nagayama, Masatoshi; Oikawa, Keiko; Koyama, Teruyuki; Itoh, Haruki
• Other Names: Tota-Maharaj Rajesh Guest Editor.
• Is Part Of: Cardiology research and practice. Volume 2019(2019)
• Publication Date: 2019-06-04
• Subjects: Cardiology -- Research -- Periodicals; Cardiology -- Periodicals; Cardiology; Cardiology; Cardiology -- Research; Electronic journals; Periodicals; Periodicals; 616.12
• DOI: 10.1155/2019/1840894
• Languages: English
• ISSNs: 2090-8016

Abstract

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.