Cost-effectiveness analysis of long-term moderate exercise training in chronic heart failure

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Abstract

The purpose of this study is to perform a cost-effectiveness analysis of long-term moderate exercise training (ET) in patients with stable chronic heart failure. In particular, the study focuses on the survival analysis and cost savings from the reduction in the hospitalization rate in the exercise group. In the past 10 years, ET has been shown to be beneficial for patients with stable class II and III heart failure in many randomized clinical trials. However, the cost-effectiveness of a long-term ET program has not been addressed for outcomes related to morbidity/mortality end points or health care utilization. We examined the cost-effectiveness of a 14-month long-term training in patients with stable chronic heart failure. The estimated increment cost for the training group, $3,227/patient, was calculated by subtracting the averted hospitalization cost, $1,336/patient, from the cost of ET and wage lost due to ET, estimated at $4,563/patient. For patients receiving ET, the estimated increment in life expectancy was 1.82 years/person in a time period of 15.5 years, compared with patients in the control group. The cost-effectiveness ratio for long-term ET in patients with stable heart failure was thus determined at $1,773/life-year saved, at a 3% discount rate. Long-term ET in patients with stable chronic heart failure is cost-effective and prolongs survival by an additional 1.82 years at a low cost of $1,773 per/life-year saved.

Section snippets

Methods

To determine the cost-effectiveness of a 14-month-long moderate ET in heart failure, published results from a recent randomized controlled clinical trial were used.1 A standard cost-effectiveness analysis was performed11 and the cost-effectiveness ratio, expressed in dollars per year of life saved, was calculated. A discount rate of 3% was selected and applied to costs and consequences to address subjects’ time preference for the future costs and benefits.11 In our analysis, costs referred to

Incremental cost of exercise program

In the randomized trial, the hospitalization rate during the follow-up period was 29% in the control group (there were 14 admissions in the control group consisting of 49 patients) and 10% in the exercise group (only 5 of 50 patients in the training group were admitted). Assuming that the hospitalization rates for the training and the control groups were identical after the follow-up period, a reduction of 19%, simply the difference between the 2 groups in hospitalization rate, was obtained for

Discussion

Because the present findings have no precedence in the current literature, no direct comparison could be established with other cost-effectiveness values. However, reference can be made to a familiar categorization scheme19 in which a cost-effectiveness value of ≤$20,000 indicates a highly cost-effective intervention, a value of $20,000 to $40,000 describes consistency with currently funded interventions, and a value >$40,000 indicates marginal or poor cost-effectiveness. On this basis,

References (26)

  • M.J Sullivan et al.

    Exercise training in patients with severe left ventricular dysfunctionhemodynamic and metabolic effects

    Circulation

    (1988)
  • A.J.S Coats et al.

    Controlled trial of physical training in chronic heart failureexercise performance, hemodynamics, ventilation, and autonomic function

    Circulation

    (1992)
  • B Horning et al.

    Physical training improves endothelial function in patients with chronic hear failure

    Circulation

    (1996)
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    This study was supported in part by a grant from the Joseph L. Mailman School of Public Health, Division of Health Policy and Management, Columbia University, New York, New York and Merck & Co., Inc., West Point, Pennsylvania. Manuscript received August 16, 2000; revised manuscript received and accepted October 30, 2000.

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