Economic benefits of secondary and tertiary cardiac rehabilitation: a critical study

At least seven criticisms have been advanced to those suggesting economic benefit from secondary and tertiary rehabilitation: (i) many existing data sets are weak, (ii) many analyses have been limited to self-selected exercise participants, (iii) the distribution of benefits between different sectors of the economy has been ignored, (iv) programme participation is not necessarily synonymous with economic benefit, (v) the discount rate has been neglected, (vi) opportunity costs have not been considered, and (viii) possible increases in pension costs could outweigh supposed benefits. Although there are limitations in the original calculations of economic benefit, there are also weaknesses in their critique. Cost-effectiveness analysis has some attractions over cost-benefit analysis, because areas of fiscal and ethical uncertainty are avoided. Given that patients who develop chronic diseases will require some form of treatment, exercise offers an attractive option for both secondary and tertiary prevention, particularly if programmes have low facility and opportunity costs, and attention is directed to high-risk segments of the population. The challenge to incorporate the lessons from such analyses into governmental and corporate-decision making.