Cost-Effectiveness of Cardiac Rehabilitation in Older Adults With Coronary Heart Disease.
| Autor: | Shepard DS; Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Dr Shepard, and Ms Zakir); and Vermont Center for Behavior and Health, College of Medicine, University of Vermont, Burlington (Drs Gaalema and Ades)., Zakir S, Gaalema DE, Ades PA |
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| Jazyk: | angličtina |
| Zdroj: | Journal of cardiopulmonary rehabilitation and prevention [J Cardiopulm Rehabil Prev] 2024 Mar 01; Vol. 44 (2), pp. 107-114. Date of Electronic Publication: 2023 Oct 04. |
| DOI: | 10.1097/HCR.0000000000000827 |
| Abstrakt: | Purpose: While cardiac rehabilitation (CR) is recommended and effective following acute cardiac events, it remains underutilized, particularly in older adults. A study of 601 099 Medicare beneficiaries ≥65 yr hospitalized for coronary heart disease compared 5-yr mortality in users and nonusers of CR. Using instrumental variables (IV), CR improved mortality by 8.0% ( P < .001). A validation analysis based on 70 040 propensity-based (PB) matched pairs gave a similar gain (8.3%, P < .0001). The present cost-effectiveness analysis builds on these mortality results. Methods: Using the framework of the Second Panel on Cost-Effectiveness Analysis, we calculated the incremental cost-effectiveness ratio (ICER) gained due to CR. We accessed the costs from this cohort, inflated to 2022 prices, and assessed the relationship of quality-adjusted life years (QALY) to life years from a systematic review. We estimated the ICER of CR by modeling lifetime costs and QALY from national life tables using IV and PB. Results: Using IV, CR added 1.344 QALY (95% CI, 0.543-2.144) and $40 472 in costs over the remaining lifetimes of participants. The ICER was $30 188 (95% CI, $18 175-$74 484)/QALY over their lifetimes. Using the PB analysis, the corresponding lifetime values were 2.018 (95% CI, 1.001-3.035) QALY, $66 590, and an ICER of $32 996 (95% CI, $21 942-$66 494)/QALY. Conclusions: Cardiac rehabilitation was highly cost-effective using guidelines established by the World Health Organization and the US Department of Health and Human Services. The favorable clinical effectiveness and cost-effectiveness of CR, along with low use by Medicare beneficiaries, support the need to increase CR use. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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