Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis
Background. Medical costs associated with cardiovascular disease are increasing considerably worldwide; therefore, an efficacious, cost-effective therapy which allows the effective use of medical resources is vital. There have been few economic evaluations of cardiac rehabilitation (CR), especially...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Cardiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2019/1840894 |
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| author | Tomoyuki Takura Nozomi Ebata-Kogure Yoichi Goto Masahiro Kohzuki Masatoshi Nagayama Keiko Oikawa Teruyuki Koyama Haruki Itoh |
| author_facet | Tomoyuki Takura Nozomi Ebata-Kogure Yoichi Goto Masahiro Kohzuki Masatoshi Nagayama Keiko Oikawa Teruyuki Koyama Haruki Itoh |
| author_sort | Tomoyuki Takura |
| collection | DOAJ |
| description | Background. Medical costs associated with cardiovascular disease are increasing considerably worldwide; therefore, an efficacious, cost-effective therapy which allows the effective use of medical resources is vital. There have been few economic evaluations of cardiac rehabilitation (CR), especially meta-analyses of medical cost versus patient outcome. Methods. The target population in this meta-analysis included convalescent and comprehensive CR patients with coronary artery disease (CAD), the status most commonly observed postmyocardial infarction (MI). Here, we evaluated medical costs, quality-adjusted life year (QALY), cost-effectiveness, mortality, and life year (LY). Regarding cost-effectiveness analysis, we analyzed medical costs per QALY, medical costs per LY, and the incremental cost-utility ratio (ICUR). We then examined the differences in effects for the 2 treatment arms (CR vs. usual care (UC)) using the risk ratio (RR) and standardized mean difference (SMD). Results. We reviewed 59 studies and identified 5 studies that matched our selection criteria. In total, 122,485 patients were included in the analysis. Meta-analysis results revealed that the CR arm significantly improved QALY (SMD: −1.78; 95% confidence interval (CI): −2.69, −0.87) compared with UC. Although medical costs tended to be higher in the CR arm compared to the UC arm (SMD: 0.02; 95% CI: −0.08, 0.13), cost/QALY was significantly improved in the CR arm compared with the UC arm (SMD: −0.31; 95% CI: −0.53, −0.09). The ICURs for the studies (4 RCTs and 1 model analysis) were as follows: −48,327.6 USD/QALY; −5,193.8 USD/QALY (dominant, CR is cheaper and more effective than UC); and 4,048.0 USD/QALY, 17,209.4 USD/QALY, and 26,888.7 USD/QALY (<50,000 USD/QALY, CR is costlier but more effective than UC), respectively. Therefore, there were 2 dominant and 3 effective results. Conclusions. While there are some limitations, primarily regarding data sources, our results suggest that CR is potentially cost-effective. |
| format | Article |
| id | doaj-art-fcee24ef0cc94922bc42b2374bfe8433 |
| institution | OA Journals |
| issn | 2090-8016 2090-0597 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
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| series | Cardiology Research and Practice |
| spelling | doaj-art-fcee24ef0cc94922bc42b2374bfe84332025-08-20T02:22:38ZengWileyCardiology Research and Practice2090-80162090-05972019-01-01201910.1155/2019/18408941840894Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-AnalysisTomoyuki Takura0Nozomi Ebata-Kogure1Yoichi Goto2Masahiro Kohzuki3Masatoshi Nagayama4Keiko Oikawa5Teruyuki Koyama6Haruki Itoh7Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, JapanAichi Medical University, Aichi 480-1195, JapanNational Cerebral and Cardiovascular Center, Osaka 565-8565, JapanTohoku University Graduate School of Medicine, Miyagi 980-8574, JapanSakakibara Heart Institute, Tokyo 183-0003, JapanTokai University Hachioji Hospital, Tokyo 192-0032, JapanTokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo 173-0015, JapanSakakibara Heart Institute, Tokyo 183-0003, JapanBackground. Medical costs associated with cardiovascular disease are increasing considerably worldwide; therefore, an efficacious, cost-effective therapy which allows the effective use of medical resources is vital. There have been few economic evaluations of cardiac rehabilitation (CR), especially meta-analyses of medical cost versus patient outcome. Methods. The target population in this meta-analysis included convalescent and comprehensive CR patients with coronary artery disease (CAD), the status most commonly observed postmyocardial infarction (MI). Here, we evaluated medical costs, quality-adjusted life year (QALY), cost-effectiveness, mortality, and life year (LY). Regarding cost-effectiveness analysis, we analyzed medical costs per QALY, medical costs per LY, and the incremental cost-utility ratio (ICUR). We then examined the differences in effects for the 2 treatment arms (CR vs. usual care (UC)) using the risk ratio (RR) and standardized mean difference (SMD). Results. We reviewed 59 studies and identified 5 studies that matched our selection criteria. In total, 122,485 patients were included in the analysis. Meta-analysis results revealed that the CR arm significantly improved QALY (SMD: −1.78; 95% confidence interval (CI): −2.69, −0.87) compared with UC. Although medical costs tended to be higher in the CR arm compared to the UC arm (SMD: 0.02; 95% CI: −0.08, 0.13), cost/QALY was significantly improved in the CR arm compared with the UC arm (SMD: −0.31; 95% CI: −0.53, −0.09). The ICURs for the studies (4 RCTs and 1 model analysis) were as follows: −48,327.6 USD/QALY; −5,193.8 USD/QALY (dominant, CR is cheaper and more effective than UC); and 4,048.0 USD/QALY, 17,209.4 USD/QALY, and 26,888.7 USD/QALY (<50,000 USD/QALY, CR is costlier but more effective than UC), respectively. Therefore, there were 2 dominant and 3 effective results. Conclusions. While there are some limitations, primarily regarding data sources, our results suggest that CR is potentially cost-effective.http://dx.doi.org/10.1155/2019/1840894 |
| spellingShingle | Tomoyuki Takura Nozomi Ebata-Kogure Yoichi Goto Masahiro Kohzuki Masatoshi Nagayama Keiko Oikawa Teruyuki Koyama Haruki Itoh Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis Cardiology Research and Practice |
| title | Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis |
| title_full | Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis |
| title_fullStr | Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis |
| title_full_unstemmed | Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis |
| title_short | Cost-Effectiveness of Cardiac Rehabilitation in Patients with Coronary Artery Disease: A Meta-Analysis |
| title_sort | cost effectiveness of cardiac rehabilitation in patients with coronary artery disease a meta analysis |
| url | http://dx.doi.org/10.1155/2019/1840894 |
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