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Scand J Med Sci Sports. 2017 Nov;27(11):1395-1403. doi: 10.1111/sms.12738. Epub 2016 Aug 19.

Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome.

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Center for Machine Vision and Signal Analysis, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland.
Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Social and Health Services, City of Oulu, Oulu, Finland.
Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
Pharmacoeconomics & Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.


Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n = 109) or usual care (UC) group (n = 95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -€24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.


Coronary heart disease; cost-effectiveness; exercise training; rehabilitation

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