Ref ID: 21Ades PA, Pashkow FJ, Nestor JR. Cost-effectiveness of cardiac rehabilitation after myocardial infarction. J Cardpulm Rehabil 1997; 17(4): 222–231.
Economic study typeCEA, benefit measure was years of life saved (YLS)
Population, country & perspectiveMales with a post acute MI below the age of 65 years patient or insurance payer
Intervention

Comparison(s)
Cardiac rehabilitation + usual care

No cardiac rehabilitation (usual care which consisted of thrombolytic therapy coronary bypass surgery, cholesterol lowering drugs and smoking cessation).
Source of effectiveness dataPublished review of RCTs
Method of eliciting health valuations (if applicable)Not applicable
Cost components includedDirect medical costs
Currency and cost yearUSA, 1995
Results – cost per patient per alternativeThe net cost for MI was $430 in 1985 and $940 in 1995. The costs of other common interventions were not stated
Results – effectiveness per patient per alternativeCumulative all-cause mortality in the rehabilitation group was reduced by 21.2% at the end of year 1, by 22.9% at the end of 2 years and 16.9% at th end of 3 years of follow-up
Results –incremental cost- effectivenessThe cost per year of life saved was $2,130 in 1985 and the cost per year of l saved (projected) was $4,950 in 1995 (at a 5% discount rate)
Results-uncertaintyVarying the survival rate, the survival probabilities and the rehospitalisation expenses averted
Time horizon & discount rate3 years 5%
Source of fundingNot stated
CommentsQuantities and costs were reported separately, The authors based their analysis of effectiveness on studies with a randomised design, but it is not clear whether these were identified through a systematic search of the medic literature. It should be noted that estimated benefits are unlikely to be generalisable to females of the same age. As acknowledged by the authors, adjustment for quality of life could have been made
Ref ID: 2919Hall JP, Wiseman VL, King MT, Ross DL, Kovoor P, Zecchin RP et al. Economi evaluation of a randomised trial of early return to normal activities versus cardiac rehabilitation after acute myocardial infarction. Heart, Lung & Circula 2002; 11(1): 10–18.
Economic study typeCost consequence analysis. Outcomes were Quality of life (QOL) measures a four measures of return to normal activities (paid and unpaid return to any work and to pre-AMI level of work).
Population, country & perspectiveLow-risk patients after acute myocardial infarction (AMI),
Intervention

Comparison(s)
6 weeks of standard rehabilitation (REHAB, n = 70) (exercise and counselling times a week)

No formal rehabilitation (ERNA, n = 72).
Source of effectiveness dataRCT
Method of eliciting health valuations (if applicable)Not applicable
Cost components includedDirect medical cost and indirect costs
Currency and cost year$AUD, cost year not stated
Results – cost per patient per alternative$21.57/Patient/session for 14 sessions on average direct costs excluding hospital overheads

$28.12/Patient/session for 14 sessions on average total hospital costs.

The net cost that could be saved by the health service by targeting rehabilitation to high-risk patients was approximately $300 (Australian, 1999) per low-risk patient
Results – effectiveness per patient per alternativeThere were no statistically significant differences between the two groups in of the outcomes measured or in the use of other health services
Results –incremental cost- effectivenessNot done (cost minimisation)
Results-uncertaintyNot done
Time horizon & discount rate12 months and discounting was not necessary
Source of fundingPublic
CommentsDid not state the cost year. Good discussion
Ref ID: 280Oldridge N, Furlong W, Feeny D, Torrance G, Guyatt G, Crowe J et al. Econo evaluation of cardiac rehabilitation soon after acute myocardial infarction American Journal of Cardiology 1993; 72(2): 154–161.
Economic study typeCUA, QALYs, cost/QALY
Population, country & perspectivePatients with AMI and mild to moderate anxiety or depression, or both

Perspective not stated but appears to be societal
Intervention

Comparison(s)
Comprehensive cardiac rehabilitation intervention (n = 99)

Usual care (n = 102).
Source of effectiveness dataRCT and review of literature
Method of eliciting health valuations (if applicable)TTO
Cost components includedDirect medical and indirect patient costs
Currency and cost yearUS$ 1991
Results – cost per patient per alternative$480/patient. During 1-year follow-up
Results – effectiveness per patient per alternativeRehabilitation patients had fewer “other rehabilitation visits” (p < 0.0001) an gained 0.052 quality-adjusted life-year more than did the group with usual ca
Results –incremental cost- effectiveness$9,200/quality-adjusted life-year gained with cardiac rehabilitation during the year of follow-up
Results-uncertainty
Time horizon & discount rate12 months and 5%
Source of fundingNot stated
CommentsGenerally a good paper
Ref ID: 297Levin LA, Perk J, Hedback B. Cardiac rehabilitation--a cost analysis. Journal o Internal Medicine 1991; 230(5): 427–434.
Economic study typeCost consequence analysis
Population, country & perspectiveNon-selected post MI patients, societal perspective.

Mortality (total & cardiac) Readmission, non-fatal and total cardiac events
Intervention

Comparison(s)
Comprehensive cardiac rehabilitation programme 147 non-selected MI patien aged less than 65 years (124 men vs. 23 women)

Standard care after myocardial infarction (MI) non-selected MI-population ag less than 65 years (n = 158) (134 men vs. 24 women)
Source of effectiveness dataProspective non- RCT
Method of eliciting health valuations (if applicable)Not applicable
Cost components includedBoth direct and indirect costs (time costs of rehab and lost productivity)
Currency and cost yearSEK 1996
Results – cost per patient per alternativeRehab group SEK 484260 vs. SEK 557770 usual care and difference was SEK 73,500 in favour of the rehabilitated group
Results – effectiveness per patient per alternativeMortality (total & cardiac) did not differ between the groups

Readmission was less in the rehab 13.7 days vs. 19.3 days in the control p<0

They differed in non-fatal reinfaction (17.3 vs. 33.3%), total cardiac events (vs. 53.2%) p=0.001
Results –incremental cost- effectivenessNot calculated because it was a cost consequence analysis
Results-uncertaintyRemained robust
Time horizon & discount rate5 yrs, 0 &10%
Source of fundingNot stated
CommentsEven though the study was not controlled it looked at two real life clinical situations, which make the results more useful for the case for comprehensiv rehabilitation.
Ref ID: 166Taylor R, Kirby B. Cost implications of cardiac rehabilitation in older patients. Coronary Artery Disease 1999; 10(1): 53–56.
Economic study typeReview of economic evaluations including costs of the UK cardiac rehabilitatio programme
Population, country & perspectivePost-MI patients, Societal cost data for UK and effectives data from a Canadi trial
InterventionCardiac rehabilitation
Comparison(s)Usual care
Source of effectiveness dataRCT
Method of eliciting health valuations (if applicable)N/A
Cost components includedBoth direct and indirect patient costs
Currency and cost year£, 1994/5
Results – cost per patient per alternative£140.00 excluding the indirect costs

£207 including indirect costs
Results – effectiveness per patient per alternativeLife year gained per patient 0.022

QALY gained 0.052
Results –incremental cost- effectiveness£6400/life year gained

£2700/QALY gained
Results-uncertaintyNot done
Time horizon & discount rate12 weeks & 5%
Source of fundingNot stated
CommentsDid not state where they derived the cost data from, but gives insight into th situation

From: Appendix D, Health Economic Extractions

Cover of Post Myocardial Infarction
Post Myocardial Infarction: Secondary Prevention in Primary and Secondary Care for Patients Following a Myocardial Infarction [Internet].
NICE Clinical Guidelines, No. 48.
National Collaborating Centre for Primary Care (UK).
Copyright © 2007, National Collaborating Centre for Primary Care.

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