The cost-effectiveness of exercise-based cardiac rehabilitation: a systematic review of the characteristics and methodological quality of published literature

Katherine Edwards (), Natasha Jones (), Julia Newton (), Charlie Foster (), Andrew Judge (), Kate Jackson (), Nigel K. Arden () and Rafael Pinedo-Villanueva ()
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Katherine Edwards: University of Oxford
Natasha Jones: University of Oxford
Julia Newton: University of Oxford
Charlie Foster: University of Oxford
Andrew Judge: University of Oxford
Kate Jackson: University of Oxford
Nigel K. Arden: University of Oxford
Rafael Pinedo-Villanueva: University of Oxford

Health Economics Review, 2017, vol. 7, issue 1, 1-23

Abstract: Abstract Aim This descriptive review aimed to assess the characteristics and methodological quality of economic evaluations of cardiac rehabilitation (CR) programs according to updated economic guidelines for healthcare interventions. Recommendations will be made to inform future research addressing the impact of a physical exercise component on cost-effectiveness. Methods Electronic databases were searched for economic evaluations of exercise-based CR programs published in English between 2000 and 2014. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to review the methodological quality of included economic evaluations. Results Fifteen economic evaluations met the review inclusion criteria. Assessed study characteristics exhibited wide variability, particularly in their economic perspective, time horizon, setting, comparators and included costs, with significant heterogeneity in exercise dose across interventions. Ten evaluations were based on randomised controlled trials (RCTs) spanning 6–24 months but often with weak or inconclusive results; two were modelling studies; and the final three utilised longer time horizons of 3.5–5 years from which findings suggest that long-term exercise-based CR results in lower costs, reduced hospitalisations and a longer cumulative patient lifetime. None of the 15 articles met all the CHEERS quality criteria, with the majority either fully or partially meeting a selection of the assessed variables. Conclusion Evidence exists supporting the cost-effectiveness of exercise-based CR for cardiovascular disease patients. However, variability in CR program delivery and weak consistency between study perspective and design limits study comparability and therefore the accumulation of evidence in support of a particular exercise regime. The generalisability of study findings was limited due to the exclusion of patients with comorbidities as would typically be found in a real-world setting. The use of longer time-horizons would be more comparable with a chronic condition and enable economic assessments of the long-term effects of CR. As none of the articles met recent reporting standards for the economic assessment of healthcare interventions, it is recommended that future studies adhere to such guidelines.

Keywords: Cardiac rehabilitation; Cost effectiveness; Economic evaluation; Exercise; Cheers (search for similar items in EconPapers)
Date: 2017
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DOI: 10.1186/s13561-017-0173-3

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