Economic Evaluation of Exercise-Based Cardiac... : Journal of Cardiopulmonary Rehabilitation and Prevention (original) (raw)

Cardiac Rehabilitation

Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia

Rincón, Mónica MD, MA, MSc; Rojas, Maria Ximena RN, MSc; Rodriguez Romero, Viviana Alejandra MSc; Tamayo, Diana Carolina MD; Franco, Camilo MD; Castro, Hector MD, PhD; Brophy, James MD, PhD; Dennis, Rodolfo MD, MSc

Rehabilitation 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.

Correspondence: Rodolfo Dennis, MD, MSC, FACP, Departamento de Investigaciones, Torre H, 3er Piso, Fundación Cardioinfantil, Calle 163 #13b-60, Bogotá, Colombia ([email protected]).

This study was made possible by funding from COLCIENCIAS, Colombia (Grant # 223951929149-2010).

COLCIENCIAS had no role in the conception, design, analysis, interpretation of data, drafting the article, or approving the final manuscript version to be published.

The authors declare no conflicts of interest.

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.