Cost-effectiveness of supervised exercise therapy in heart failure patients - PubMed (original) (raw)
. 2011 Jul-Aug;14(5 Suppl 1):S100-7.
doi: 10.1016/j.jval.2011.05.006.
Affiliations
- PMID: 21839879
- DOI: 10.1016/j.jval.2011.05.006
Free article
Cost-effectiveness of supervised exercise therapy in heart failure patients
Eduardo M Kühr et al. Value Health. 2011 Jul-Aug.
Free article
Abstract
Objective: Exercise therapy in heart failure (HF) patients is considered safe and has demonstrated modest reduction in hospitalization rates and death in recent trials. Previous cost-effectiveness analysis described favorable results considering long-term supervised exercise intervention and significant effectiveness of exercise therapy; however, these evidences are now no longer supported. To evaluate the cost-effectiveness of supervised exercise therapy in HF patients under the perspective of the Brazilian Public Healthcare System.
Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratio of supervised exercise therapy compared to standard treatment in patients with New York Heart Association HF class II and III. Effectiveness was evaluated in quality-adjusted life years in a 10-year time horizon. We searched PUBMED for published clinical trials to estimate effectiveness, mortality, hospitalization, and utilities data. Treatment costs were obtained from published cohort updated to 2008 values. Exercise therapy intervention costs were obtained from a rehabilitation center. Model robustness was assessed through Monte Carlo simulation and sensitivity analysis. Cost were expressed as international dollars, applying the purchasing-power-parity conversion rate.
Results: Exercise therapy showed small reduction in hospitalization and mortality at a low cost, an incremental cost-effectiveness ratio of Int$26,462/quality-adjusted life year. Results were more sensitive to exercise therapy costs, standard treatment total costs, exercise therapy effectiveness, and medications costs. Considering a willingness-to-pay of Int$27,500, 55% of the trials fell below this value in the Monte Carlo simulation.
Conclusions: In a Brazilian scenario, exercise therapy shows reasonable cost-effectiveness ratio, despite current evidence of limited benefit of this intervention.
Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Similar articles
- Cost-effectiveness of implantable cardioverter-defibrillators in Brazil: primary prevention analysis in the public sector.
Ribeiro RA, Stella SF, Camey SA, Zimerman LI, Pimentel M, Rohde LE, Polanczyk CA. Ribeiro RA, et al. Value Health. 2010 Mar-Apr;13(2):160-8. doi: 10.1111/j.1524-4733.2009.00608.x. Epub 2009 Sep 2. Value Health. 2010. PMID: 19725912 - Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia.
Rincón M, Rojas MX, Rodriguez Romero VA, Tamayo DC, Franco C, Castro H, Brophy J, Dennis R. Rincón M, et al. J Cardiopulm Rehabil Prev. 2016 Jan-Feb;36(1):12-9. doi: 10.1097/HCR.0000000000000150. J Cardiopulm Rehabil Prev. 2016. PMID: 26702862 - The cost effectiveness and cost utility of valsartan in chronic heart failure therapy in Italy: a probabilistic markov model.
Pradelli L, Iannazzo S, Zaniolo O. Pradelli L, et al. Am J Cardiovasc Drugs. 2009;9(6):383-92. doi: 10.2165/11315730-000000000-00000. Am J Cardiovasc Drugs. 2009. PMID: 19929036 - The cost-effectiveness of supervised exercise for the treatment of intermittent claudication.
Bermingham SL, Sparrow K, Mullis R, Fox M, Shearman C, Bradbury A, Michaels J. Bermingham SL, et al. Eur J Vasc Endovasc Surg. 2013 Dec;46(6):707-14. doi: 10.1016/j.ejvs.2013.09.005. Epub 2013 Sep 12. Eur J Vasc Endovasc Surg. 2013. PMID: 24103792 Review. - Team-based Care for Cardiac Rehabilitation and Exercise Training in Heart Failure.
Pozehl B, McGuire R, Norman J. Pozehl B, et al. Heart Fail Clin. 2015 Jul;11(3):431-49. doi: 10.1016/j.hfc.2015.03.007. Heart Fail Clin. 2015. PMID: 26142640 Review.
Cited by
- Brazilian Cardiovascular Rehabilitation Guideline - 2020.
Carvalho T, Milani M, Ferraz AS, Silveira ADD, Herdy AH, Hossri CAC, Silva CGSE, Araújo CGS, Rocco EA, Teixeira JAC, Dourado LOC, Matos LDNJ, Emed LGM, Ritt LEF, Silva MGD, Santos MAD, Silva MMFD, Freitas OGA, Nascimento PMC, Stein R, Meneghelo RS, Serra SM. Carvalho T, et al. Arq Bras Cardiol. 2020 Jun 1;114(5):943-987. doi: 10.36660/abc.20200407. Arq Bras Cardiol. 2020. PMID: 32491079 Free PMC article. English, Portuguese. No abstract available. - Cost-effectiveness of heart failure therapies.
Rohde LE, Bertoldi EG, Goldraich L, Polanczyk CA. Rohde LE, et al. Nat Rev Cardiol. 2013 Jun;10(6):338-54. doi: 10.1038/nrcardio.2013.60. Epub 2013 Apr 23. Nat Rev Cardiol. 2013. PMID: 23609174 - Cost-effectiveness of cardiac rehabilitation: a systematic review.
Shields GE, Wells A, Doherty P, Heagerty A, Buck D, Davies LM. Shields GE, et al. Heart. 2018 Sep;104(17):1403-1410. doi: 10.1136/heartjnl-2017-312809. Epub 2018 Apr 13. Heart. 2018. PMID: 29654096 Free PMC article. - Treatment for stable coronary artery disease: a network meta-analysis of cost-effectiveness studies.
Caruba T, Katsahian S, Schramm C, Charles Nelson A, Durieux P, Bégué D, Juillière Y, Dubourg O, Danchin N, Sabatier B. Caruba T, et al. PLoS One. 2014 Jun 4;9(6):e98371. doi: 10.1371/journal.pone.0098371. eCollection 2014. PLoS One. 2014. PMID: 24896266 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous