Cost-effectiveness of cardiac rehabilitation program delivery models in patients at varying cardiac risk, reason for referral, and sex

BACKGROUND: Little is known about the relative cost-effectiveness of different secondary prevention cardiac rehabilitation (CR) program designs or how cost-effectiveness is influenced by patient clinical and demographic characteristics. The purpose of the study was (i) to evaluate the incremental cost-effectiveness of a standard 3-month CR program (SCR) versus a program distributed over 12 months (distributed CR, DCR); and (ii) to determine the effect of patient demographic characteristics (cardiac risk, cardiac diagnosis, sex) on incremental cost-effectiveness. METHODS: A two group cost-effectiveness analysis was conducted alongside a randomized controlled trial. Patients with coronary artery disease (mean age=58 years, SD+/-10) were randomized to either SCR (n=196) or DCR (n=196) and followed for 24 months. Program delivery costs, cardiac healthcare use, morbidity, mortality, and quality-adjusted life years were assessed. Cost-effectiveness was evaluated with incremental cost-utility analysis. RESULTS: In the pooled analysis, we found the probability of SCR being more cost-effective than DCR was 63-67%. The subanalysis found SCR to be the more cost-effective intervention for patients at high risk, patients with previous coronary artery bypass graft and for male patients. The DCR program was more cost-effective for patients with lower risk of disease progression and for female patients. CONCLUSION: Differences were noted in the cost-effectiveness of CR models based on cardiac risk level, reason for referral, and demographic characteristics. Our results suggest improved cost-effectiveness may be gained by triaging patients to different CR intervention models, however, further investigation is required.