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Health care delivery, economics and global health care
Original research article
Shared care versus hospital-based cardiac rehabilitation: a cost-utility analysis based on a randomised controlled trial
  1. Jannik B Bertelsen1,
  2. Nasrin Tayyari Dehbarez2,
  3. Jens Refsgaard3,
  4. Helle Kanstrup1,
  5. Søren P Johnsen4,
  6. Ina Qvist5,
  7. Bo Christensen6,
  8. Rikke Søgaard7 and
  9. Kent L Christensen1
  1. 1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Public Health, Aarhus University, Aarhus, Denmark
  3. 3Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
  4. 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  5. 5Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark
  6. 6Institute of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
  7. 7Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Jannik B Bertelsen; jannik.bertelsen{at}auh.rm.dk

Abstract

Background Changes in the organisation of chronic healthcare, an increased awareness of costs and challenges of low adherence in cardiac rehabilitation (CR) call for the exploration of more flexible CR programmes as alternatives to hospital-based CR (H-CR). A model of shared care cardiac rehabilitation (SC-CR) that included general practitioners and the municipality was developed. The aim of this study was to analyse the cost utility of SC-CR versus H-CR.

Methods The cost-utility analysis was based on a randomised controlled trial of 212 patients who were allocated to SC-CR or H-CR and followed up for 12 months. A societal cost perspective was applied that included the cost of intervention, informal time, healthcare and productivity loss. Costing was based on a microcosting approach for the intervention and on national administrative registries for the other cost categories. Quality-adjusted life years (QALYs) were based on the EuroQol 5-Dimensions measurements at baseline, after 4 months and after 12 months. Conventional cost-effectiveness methodology was employed to estimate the net benefit of SC-CR.

Results The average cost of SC-CR was 165.5 kDKK and H-CR 163 kDKK. Productivity loss comprised 74.1kDKK and 65.9 kDKK. SC-CR cost was an additional 2.5 kDKK (95% CI −38.1 to 43.1) ≈ (0.33; −5.1 to 5.8 k€) and a QALY gain of 0.02 (95% CI −0.03 to 0.06). The probability that SC-CR would be cost-effective was 59% for a threshold value of willingness to pay of 300 kDKK (k€40.3).

Conclusion CR after shared care model and H-CR are comparable and similar in socioeconomic terms.

Trial registration number NCT 01522001; Results.

  • cardiac rehabilitation
  • acute coronary syndrome
  • cost-utility
  • shared care
  • randomised controlled trial

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000584

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    Footnotes

    • Contributors JBB, KLC, BC, JR and HK designed the RCT. RS, NTD, BC, KLC and JBB designed the economic evaluation. NTD drafted the method and results sections. JBB has made the first complete paper draft. All authors contributed to the final manuscript.

    • Funding The study was financed by a grant from the Danish Heart Association.

    • Competing interests None declared.

    • Ethics approval The Central Denmark Region Committees on Biomedical Research Ethics (j.nr. M-20110135) and the Danish Data Protection Agency approved the study protocol (j.nr. 2011–41-6533 changed to 2014–41-3342 in 2014).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.