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Int Health. 2016 Mar;8(2):77-82. doi: 10.1093/inthealth/ihv047. Epub 2015 Jul 24.

Cardiac rehabilitation in low- and middle-income countries: a review on cost and cost-effectiveness.

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College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Library & Information Services, UHN Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
Cardiovascular Health Clinic, Mayo Clinic and Foundation Rochester, Minnesota, USA.



By 2030, more than 80% of cardiovascular disease-related deaths and disability-adjusted life years will occur in the 139 low- and middle-income (LMIC) countries. Cardiac rehabilitation (CR) has been demonstrated to be effective and cost-effective mainly based on data from high-income countries. The purpose of this paper was to review the literature for cost and cost-effectiveness data on CR in LMICs.


MEDLINE (Ovid) and EMBASE (Ovid) electronic databases were searched for CR 'cost' and 'cost-effectiveness' data in LMICs.


Five CR publications with cost and cost-effectiveness data from middle-income countries were identified with none from low-income countries. Studies from Brazil demonstrated mean monthly savings of US$190 for CR, with a US$48 increase in a control group with mean costs of US$503 for a 3-month CR program. Mean costs to the public health care system of US$360 and US$540 when paid out-of-pocket were reported for a 3-month CR program in seven Latin American middle-income countries. Cardiac rehabilitation is reported to be cost-effective in both Brazil and Colombia.


Cardiac rehabilitation for patients with heart failure in Brazil and Colombia was estimated to be cost-effective. However, given the limited health care budgets in many LMICs, affordable CR models will need to be developed for LMICs, particularly for low-income countries.


Cardiac rehabilitation; Cardiovascular disease; Cost; Cost-effectiveness; Low-income country; Middle-income country

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