Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

Tina Birgitte Hansen; Ann Dorthe Zwisler; Selina Kikkenborg Berg; Kirstine Lærum Sibilitz; Lau Caspar Thygesen; Jakob Kjellberg; Patrick Doherty; Neil Oldridge; Rikke Søgaard

doi:10.1177/2047487317689908

Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

Tina Birgitte Hansen, Ann Dorthe Zwisler, Selina Kikkenborg Berg, Kirstine Lærum Sibilitz, Lau Caspar Thygesen, Jakob Kjellberg, Patrick Doherty, Neil Oldridge, Rikke Søgaard

Health Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of cardiac rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac rehabilitation after heart valve surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of cardiac rehabilitation.

Original language	English
Article number	2047487317689908
Number of pages	10
Journal	European journal of preventive cardiology
Early online date	25 Jan 2017
DOIs	https://doi.org/10.1177/2047487317689908
Publication status	E-pub ahead of print - 25 Jan 2017

Bibliographical note

© 2017, The European Society of Cardiology. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

Access to Document

10.1177/2047487317689908

Hansen et al
© 2017, The European Society of Cardiology. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.
Accepted author manuscript, 106 KBLicence: Unspecified

Cite this

Hansen, T. B., Zwisler, A. D., Berg, S. K., Sibilitz, K. L., Thygesen, L. C., Kjellberg, J., Doherty, P., Oldridge, N., & Søgaard, R. (2017). Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care. European journal of preventive cardiology, Article 2047487317689908. Advance online publication. https://doi.org/10.1177/2047487317689908

@article{268fc1ed3abb49a2a06045e0e613d919,

title = "Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care",

abstract = "Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of cardiac rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac rehabilitation after heart valve surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of cardiac rehabilitation.",

author = "Hansen, {Tina Birgitte} and Zwisler, {Ann Dorthe} and Berg, {Selina Kikkenborg} and Sibilitz, {Kirstine L{\ae}rum} and Thygesen, {Lau Caspar} and Jakob Kjellberg and Patrick Doherty and Neil Oldridge and Rikke S{\o}gaard",

note = "{\textcopyright} 2017, The European Society of Cardiology. This is an author-produced version of the published paper. Uploaded in accordance with the publisher{\textquoteright}s self-archiving policy. Further copying may not be permitted; contact the publisher for details.",

year = "2017",

month = jan,

day = "25",

doi = "10.1177/2047487317689908",

language = "English",

journal = "European journal of preventive cardiology",

issn = "2047-4873",

publisher = "SAGE",

}

TY - JOUR

T1 - Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

AU - Hansen, Tina Birgitte

AU - Zwisler, Ann Dorthe

AU - Berg, Selina Kikkenborg

AU - Sibilitz, Kirstine Lærum

AU - Thygesen, Lau Caspar

AU - Kjellberg, Jakob

AU - Doherty, Patrick

AU - Oldridge, Neil

AU - Søgaard, Rikke

N1 - © 2017, The European Society of Cardiology. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

PY - 2017/1/25

Y1 - 2017/1/25

N2 - Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of cardiac rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac rehabilitation after heart valve surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of cardiac rehabilitation.

AB - Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality-adjusted life years (-0.000; 95% CI -0.021 to 0.020) between groups. However, approximately 70% of the cost and effect differences were located below the x-axis in the cost-effectiveness plane, and the cost-effectiveness acceptability curves showed that the probability for cost- effectiveness of cardiac rehabilitation compared to usual care is at minimum 75%, driven by a tendency towards costs savings. Conclusions Cardiac rehabilitation after heart valve surgery may not have improved health-related quality of life in this study, but is likely to be cost-effective for society, outweighing the extra costs of cardiac rehabilitation.

U2 - 10.1177/2047487317689908

DO - 10.1177/2047487317689908

M3 - Article

C2 - 28121172

SN - 2047-4873

JO - European journal of preventive cardiology

JF - European journal of preventive cardiology

M1 - 2047487317689908

ER -