Article Text

Download PDFPDF

Original research
Cost–utility analysis of learning and coping versus standard education in cardiac rehabilitation: a randomised controlled trial with 3 years of follow-up
  1. Nasrin Tayyari Dehbarez1,
  2. Camilla Palmhøj Nielsen1,
  3. Bettina Wulff Risør1,
  4. Claus Vinther Nielsen1,2 and
  5. Vibeke Lynggaard3
  1. 1DEFACTUM, Aarhus N, Denmark
  2. 2Department of Public Health, Aarhus Universitet, Aarhus C, Denmark
  3. 3Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
  1. Correspondence to Dr Nasrin Tayyari Dehbarez; nastay{at}


Objectives To enhance adherence to cardiac rehabilitation (CR), a patient education programme called ‘learning and coping’ (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost–utility of the LC-programme compared with the standard CR-programme.

Methods 825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3 years.

A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves.

Results No statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95% CI –3828 to 12 533) or in QALY (–0.006; 95% CI –0.053 to 0.042). At a threshold of 40 000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%.

Conclusions While the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.

  • cardiac rehabilitation
  • education
  • heart failure

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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Correction notice This paper has been updated since first published to correct author name 'Bettina Wulff Risør'

  • Contributors All the authors contributed to conception or design of the study. VL participated in the design, planning and co-ordination of the LC-REHAB trial and provided details of the intervention and results of the programme adherence and other relevant information regarding the trial. NTD and BWR contributed to data analysis. NTD drafted the manuscript and all authors contributed to interpretation of the results, critically revised the manuscript and gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

  • Funding This study was funded by TrygFonden (grant no. 125317); however, the LC-REHAB trial was funded by the Danish Ministry of Health, the Health Research Fund of Central Denmark Region and TrygFonden.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available. The data contain personal information and are not available.

Linked Articles