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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia
Mónica Rincón1, Maria Ximena Rojas, Viviana Alejandra Rodriguez Romero
1Rehabilitation Service (Dr Rincón), Fundación Cardioinfantil, Bogotá, Colombia; Department of Clinical Epidemiology and Biostatistics (Ms Rojas, Ms Rodriguez Romero, Dr Tamayo, Dr Castro, and Dr Dennis), Pontificia Universidad Javeriana, Bogotá, Colombia; Research Department (Drs Tamayo and Dennis), Fundacion Cardioinfantil, Bogotá, Colombia; Heart Failure Clinic (Dr Franco), Department of Cardiology, Fundación Cardioinfantil, Bogotá, Colombia; and Royal Victoria Hospital and McGill University (Dr Brophy), Montreal, Canada.
Insights
Cardiac rehabilitation (CR) for chronic heart failure (CHF) is cost-effective in low-income countries. This exercise-based program reduces hospitalizations, improving patient quality of life with minimal additional cost.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Cardiac rehabilitation (CR) for chronic heart failure (CHF) faces payer resistance in low- and middle-income countries due to limited cost-effectiveness data.
- Evidence is needed to inform healthcare decision-making regarding CR for CHF patients in these regions.
Purpose of the Study:
- To evaluate the cost-effectiveness of an exercise-based CR program for patients with CHF in Colombia.
- To provide data supporting CR adoption by third-party payers in resource-limited settings.
Main Methods:
- A 12-week exercise-based CR program's costs were estimated in Colombia.
- Data on ambulatory care, hospitalizations for uncompensated CHF, and CR's impact on these rates were collected and analyzed.
- A 5-year cost-effectiveness model was developed from a third-party payer perspective.
Main Results:
- The 12-week CR program cost between US$265-US$369 per patient.
- Ambulatory care costs averaged US$128/patient/month; hospitalization costs were US$3621/event.
- CR reduced yearly hospitalization incidence from 0.216 to 0.154, with an incremental cost of US$998 per QALY.
Conclusions:
- Exercise-based CR is a cost-effective strategy for CHF patients in settings like Colombia.
- CR offers improved quality of life and minimal incremental costs, primarily through reduced hospitalization rates.
- Findings support CR implementation for CHF in resource-constrained healthcare systems.
Purpose:
Cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) has met with resistance from third-party payers in low- and middle-income countries because of lack of evidence regarding its cost-effectiveness. We aimed to provide information to help better inform this decision-making process.
Methods:
Costs associated with a 12-week exercise-based rehabilitation program in Colombia for patients with CHF were estimated. We collected data on all medical resources used in ambulatory care and data on hospital costs incurred for treating patients with uncompensated CHF. A literature search to establish the hospitalization rates because of uncompensated CHF, death because of CHF, and potential decreases in these data because of the utilization of CR was conducted. We modeled incremental costs and effectiveness over a period of 5 years from the perspective of the third-party payer.
Results:
All costs were converted from Colombian pesos to US dollars. For an exercise-based CR program of 12-week duration (36 sessions), costs ranged from US$265 to US$369 per patient. Monthly costs associated with ambulatory care of CHF averaged US$128 ± US$321 per patient, and hospitalization costs were US$3621 ± US$5 444 per event. Yearly hospitalization incidence rates with and without CR were 0.154 and 0.216, respectively. The incremental cost of CR would be US$998 per additional quality-adjusted life-year. Sensitivity analysis did not significantly change these results.
Conclusions:
Cardiac rehabilitation in patients with CHF in settings such as Colombia can be a cost-effective strategy, with minimal incremental costs and better quality of life, mainly because of decreased rates of hospitalization.
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