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Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter?
Eur J Cardiovasc Prev Rehabil. 2008 Oct; 15(5):608-15.EJ

Abstract

BACKGROUND

Few healthcare economic evaluations, and none in cardiac rehabilitation, report results based on both community and patient preferences for health outcomes. We published the results of a randomized trial of cardiac rehabilitation after myocardial infarction in 1994 in which preferences were measured using both perspectives but only patient preferences were reported. This secondary analysis uses both types of preference measurements.

METHODS

We collected community Quality of Well-Being (QWB) and patient Time Trade-off (TTO) preference scores from 188 patients (rehabilitation, n=93; usual care, n=95) on entry into the trial, at 2 months (end of the intervention) and again at 4, 8, and 12 months. Mean preference scores over the 12-month follow-up study period, estimates of quality-adjusted life years (QALYs) gained per patient, incremental cost-effectiveness ratios [costs inflated to 2006 US dollars] and probabilities of the cost-effectiveness of rehabilitation for costs per QALY up to USD100,000 are reported.

RESULTS

Mean QWB preference scores were lower (P<0.01) than the corresponding mean TTO preference scores at each assessment point. The 12-month changes in mean QWB and TTO preference scores were large and positive (P<0.001) with rehabilitation patients gaining a mean of 0.011 (95% confidence interval, -0.030 to +0.052) more QWB-derived QALYs, and 0.040 (-0.026, 0.107) more TTO-derived QALYs, per patient than usual care patients. The incremental cost-effectiveness ratio for QWB-derived QALYs was estimated at $60 270/QALY (about euro50 600/QALY) and at $16 580/QALY (about euro13 900/QALY) with TTO-derived QALYs. With a willingness to spend $100 000/QALY, the probability of rehabilitation being cost-effective is 0.58 for QWB-derived QALYs and 0.83 for TTO-derived QALYs.

CONCLUSION

This secondary analysis of data from a randomized trial indicates that cardiac rehabilitation is cost-effective from a community perspective and highly cost-effective from the perspective of patients.

Authors+Show Affiliations

School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, Comprehensive Cardiovascular Care Group and Aurora St Luke's and Aurora Sinai, Milwaukee, WI 53217, USA. neilb@uwm.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18800005

Citation

Oldridge, Neil, et al. "Community or Patient Preferences for Cost-effectiveness of Cardiac Rehabilitation: Does It Matter?" European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups On Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, vol. 15, no. 5, 2008, pp. 608-15.
Oldridge N, Furlong W, Perkins A, et al. Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter? Eur J Cardiovasc Prev Rehabil. 2008;15(5):608-15.
Oldridge, N., Furlong, W., Perkins, A., Feeny, D., & Torrance, G. W. (2008). Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter? European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups On Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 15(5), 608-15. https://doi.org/10.1097/HJR.0b013e328304fec1
Oldridge N, et al. Community or Patient Preferences for Cost-effectiveness of Cardiac Rehabilitation: Does It Matter. Eur J Cardiovasc Prev Rehabil. 2008;15(5):608-15. PubMed PMID: 18800005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter? AU - Oldridge,Neil, AU - Furlong,William, AU - Perkins,Anthony, AU - Feeny,David, AU - Torrance,George W, PY - 2008/9/19/pubmed PY - 2009/1/10/medline PY - 2008/9/19/entrez SP - 608 EP - 15 JF - European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology JO - Eur J Cardiovasc Prev Rehabil VL - 15 IS - 5 N2 - BACKGROUND: Few healthcare economic evaluations, and none in cardiac rehabilitation, report results based on both community and patient preferences for health outcomes. We published the results of a randomized trial of cardiac rehabilitation after myocardial infarction in 1994 in which preferences were measured using both perspectives but only patient preferences were reported. This secondary analysis uses both types of preference measurements. METHODS: We collected community Quality of Well-Being (QWB) and patient Time Trade-off (TTO) preference scores from 188 patients (rehabilitation, n=93; usual care, n=95) on entry into the trial, at 2 months (end of the intervention) and again at 4, 8, and 12 months. Mean preference scores over the 12-month follow-up study period, estimates of quality-adjusted life years (QALYs) gained per patient, incremental cost-effectiveness ratios [costs inflated to 2006 US dollars] and probabilities of the cost-effectiveness of rehabilitation for costs per QALY up to USD100,000 are reported. RESULTS: Mean QWB preference scores were lower (P<0.01) than the corresponding mean TTO preference scores at each assessment point. The 12-month changes in mean QWB and TTO preference scores were large and positive (P<0.001) with rehabilitation patients gaining a mean of 0.011 (95% confidence interval, -0.030 to +0.052) more QWB-derived QALYs, and 0.040 (-0.026, 0.107) more TTO-derived QALYs, per patient than usual care patients. The incremental cost-effectiveness ratio for QWB-derived QALYs was estimated at $60 270/QALY (about euro50 600/QALY) and at $16 580/QALY (about euro13 900/QALY) with TTO-derived QALYs. With a willingness to spend $100 000/QALY, the probability of rehabilitation being cost-effective is 0.58 for QWB-derived QALYs and 0.83 for TTO-derived QALYs. CONCLUSION: This secondary analysis of data from a randomized trial indicates that cardiac rehabilitation is cost-effective from a community perspective and highly cost-effective from the perspective of patients. SN - 1741-8267 UR - https://www.unboundmedicine.com/medline/citation/18800005/Community_or_patient_preferences_for_cost_effectiveness_of_cardiac_rehabilitation:_does_it_matter DB - PRIME DP - Unbound Medicine ER -