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Original research article
Exercise-based cardiac rehabilitation after heart valve surgery: cost analysis of healthcare use and sick leave
  1. T B Hansen1,2,3,
  2. A D Zwisler3,4,5,
  3. S K Berg3,
  4. K L Sibilitz3,
  5. L C Thygesen4,
  6. P Doherty6 and
  7. R Søgaard7,8
  1. 1Department of Cardiology, Roskilde Hospital, Roskilde, Denmark
  2. 2Centre for Applied Health Services Research, University of Southern Denmark, Odense, Denmark
  3. 3Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  4. 4National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  5. 5National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense, Odense, Denmark
  6. 6Department of Health Sciences, University of York, York, UK
  7. 7Department of Public Health, Aarhus University, Aarhus, Denmark
  8. 8Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to TB Hansen; tbh{at}


Background Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR on the costs of healthcare use and sick leave among heart valve surgery patients over 12 months post surgery.

Methods We conducted a nationwide survey on the CR participation of all patients having undergone valve surgery between 1 January 2011 and 30 June 2011 (n=667). Among the responders (n=500, 75%), the resource use categories of primary and secondary healthcare, prescription medication and sick leave were analysed for CR participants (n=277) and non-participants (n=223) over 12 months. A difference-in-difference analysis was undertaken. All estimates were presented as the means per patient (95% CI) based on non-parametric bootstrapping of SEs.

Results Total costs during the 12 months following surgery were €16 065 per patient (95% CI 13 730 to 18 399) in the CR group and €15 182 (12 695 to 17 670) in the non-CR group. CR led to 5.6 (2.9 to 8.3, p<0.01) more outpatient visits per patient. No statistically significant differences in other cost categories or total costs €1330 (−4427 to 7086, p=0.65) were found between the groups.

Conclusions CR, as provided in Denmark, can be considered cost neutral. CR is associated with more outpatient visits, but CR participation potentially offsets more expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis.


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