Nasrin Tayyari Dehbarez; Camilla Palmhøj Nielsen; Bettina Wulff Risør; Claus Vinther Nielsen; Vibeke Lynggaard.
Objectives
To enhance adherence to cardiac rehabilitation (CR), a patient education programme called ‘learning and coping’ (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost–utility of theLC-programme compared with the standard CR-programme.
Methods
825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3?years.
A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multipleimputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means andbootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectivenessacceptability curves.
Results
No statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95%?CI –3828 to 12 533) or in QALY (–0.006; 95%?CI –0.053 to 0.042). At a threshold of 40?000 Euros, the LC-programme wasfound to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, theprobability of cost-effectiveness increased to 91%.
Conclusions
While the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups ofpatients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneitydue to the small sample size in this subgroup.
Link: Cost–utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trialwith 3 years of follow-up