Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Public Health Policy

Background:

• Acute coronary syndrome (ACS) survivors require effective post-event management to improve outcomes and reduce long-term healthcare burdens.
• Cardiac rehabilitation (CR) programs offer a structured approach to recovery, but their cost-effectiveness in public health systems, particularly in low-resource settings, requires thorough evaluation.
• Chile's public health system faces the challenge of optimizing resource allocation for chronic disease management, including post-ACS care.

Purpose of the Study:

• To evaluate the cost-effectiveness of three distinct exercise-based cardiac rehabilitation (CR) models compared to standard care for survivors of acute coronary syndrome (ACS) within Chile's public health system.
• To inform policy decisions regarding the implementation and resource allocation for CR programs in Chile.

Main Methods:

• A Markov model was developed with five health states (ACS survivor, second ACS, complications, general mortality, cardiovascular mortality) to simulate patient pathways over a lifetime.
• Transition probabilities were derived from a systematic review, and health benefits were measured using the EQ-5D-3L survey, with costs quantified from national studies and microcosting.
• Three CR scenarios were analyzed: current practice, South American guidelines, and a low-resource model, with deterministic and probabilistic sensitivity analyses performed.

Main Results:

• All three cardiac rehabilitation (CR) models demonstrated favorable cost-effectiveness ratios compared to standard care: $722 (standard model), $1247 (South American model), and $666 (low-resource model).
• The incremental cost-effectiveness ratios (ICERs) suggest significant value for money across different CR implementation strategies.
• Sensitivity analyses identified relative risk for complications and second ACS events as key drivers of uncertainty.

Conclusions:

• Exercise-based cardiac rehabilitation (CR) is highly cost-effective for acute coronary syndrome (ACS) survivors within Chile's public health system, even when considering a high willingness-to-pay threshold (1 GDP per capita).
• The findings support the expansion and optimization of CR programs as a valuable investment for improving cardiovascular health outcomes and managing healthcare costs.
• The study provides robust evidence for policymakers to prioritize CR services, particularly adaptable models for resource-constrained environments.