Nasrin Tayyari Dehbarez; Vibeke Lynggaard; Ole May; Rikke Søgaard
Background
Learning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitationprogramme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitationprogramme for patients with ischemic heart disease and heart failure.
Methods
The study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standardrehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical trainingand education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal costperspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based ona micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjustedlife years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preferenceweights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodologywas employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statisticalanalysis was based on means and bootstrapped standard errors.
Results
An additional cost of DKK 6,043 (95 % CI -5,697; 17,783) and a QALY gain of 0.005 (95 % CI -0.001; 0.012) was estimatedfor LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better healthafter the intervention. The probability that LC would be cost-effective did not exceed 29 % for any threshold values ofwillingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that theprobability of cost-effectiveness increased to 62 % over the threshold values.
Discussion
The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-upshould be evaluated before a definite conclusion is drawn.
Conclusion
Future research should assess the LC strategies' long-term efficacy and cost-utility.