Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis.
Cardiac rehabilitation
Cost-effectiveness
Hybrid
Telerehabilitation
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
20 May 2023
20 May 2023
Historique:
received:
07
01
2023
accepted:
14
05
2023
medline:
22
5
2023
pubmed:
20
5
2023
entrez:
19
5
2023
Statut:
epublish
Résumé
Traditional cardiac rehabilitation programs are centre-based and clinically supervised, with their safety and effectiveness well established. Notwithstanding the established benefits, cardiac rehabilitation remains underutilised. A possible alternative would be a hybrid approach where both centre-based and tele-based methods are combined to deliver cardiac rehabilitation to eligible patients. The objective of this study was to determine the long-term cost-effectiveness of a hybrid cardiac telerehabilitation and if it should be recommended to be implemented in the Australian context. Following a comprehensive literature search, we chose the Telerehab III trial intervention that investigated the effectiveness of a long-term hybrid cardiac telerehabilitation program. We developed a decision analytic model to estimate the cost-effectiveness of the Telerehab III trial using a Markov process. The model included stable cardiac disease and hospitalisation health states and simulations were run using one-month cycles over a five-year time horizon. The threshold for cost-effectiveness was set at $AU 28,000 per quality-adjusted life-year (QALY). For the base analysis, we assumed that 80% completed the programme. We tested the robustness of the results using probabilistic sensitivity and scenario analyses. Telerehab III intervention was more effective but more costly and was not cost-effective, at a threshold of $28,000 per QALY. For every 1,000 patients who undergo cardiac rehabilitation, employing the telerehabilitation intervention would cost $650,000 more, and 5.7 QALYs would be gained, over five years, compared to current practice. Under probabilistic sensitivity analysis, the intervention was cost-effective in only 18% of simulations. Similarly, if the intervention compliance was increased to 90%, it was still unlikely to be cost-effective. Hybrid cardiac telerehabilitation is highly unlikely to be cost-effective compared to the current practice in Australia. Exploration of alternative models of delivering cardiac telerehabilitation is still required. The results presented in this study are useful for policymakers wanting to make informed decisions about investment in hybrid cardiac telerehabilitation programs.
Sections du résumé
BACKGROUND
BACKGROUND
Traditional cardiac rehabilitation programs are centre-based and clinically supervised, with their safety and effectiveness well established. Notwithstanding the established benefits, cardiac rehabilitation remains underutilised. A possible alternative would be a hybrid approach where both centre-based and tele-based methods are combined to deliver cardiac rehabilitation to eligible patients. The objective of this study was to determine the long-term cost-effectiveness of a hybrid cardiac telerehabilitation and if it should be recommended to be implemented in the Australian context.
METHODS
METHODS
Following a comprehensive literature search, we chose the Telerehab III trial intervention that investigated the effectiveness of a long-term hybrid cardiac telerehabilitation program. We developed a decision analytic model to estimate the cost-effectiveness of the Telerehab III trial using a Markov process. The model included stable cardiac disease and hospitalisation health states and simulations were run using one-month cycles over a five-year time horizon. The threshold for cost-effectiveness was set at $AU 28,000 per quality-adjusted life-year (QALY). For the base analysis, we assumed that 80% completed the programme. We tested the robustness of the results using probabilistic sensitivity and scenario analyses.
RESULTS
RESULTS
Telerehab III intervention was more effective but more costly and was not cost-effective, at a threshold of $28,000 per QALY. For every 1,000 patients who undergo cardiac rehabilitation, employing the telerehabilitation intervention would cost $650,000 more, and 5.7 QALYs would be gained, over five years, compared to current practice. Under probabilistic sensitivity analysis, the intervention was cost-effective in only 18% of simulations. Similarly, if the intervention compliance was increased to 90%, it was still unlikely to be cost-effective.
CONCLUSION
CONCLUSIONS
Hybrid cardiac telerehabilitation is highly unlikely to be cost-effective compared to the current practice in Australia. Exploration of alternative models of delivering cardiac telerehabilitation is still required. The results presented in this study are useful for policymakers wanting to make informed decisions about investment in hybrid cardiac telerehabilitation programs.
Identifiants
pubmed: 37208666
doi: 10.1186/s12913-023-09546-w
pii: 10.1186/s12913-023-09546-w
pmc: PMC10198753
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
512Subventions
Organisme : SOLVE-CHD Australian Government National Health and Medical Research Council (NHMRC) Synergy Grant
ID : GNT1182301
Organisme : SOLVE-CHD Australian Government National Health and Medical Research Council (NHMRC) Synergy Grant
ID : GNT1182301
Organisme : Australian Government National Health and Medical Research Council (NHMRC) Investigator Grant
ID : GNT1143538
Informations de copyright
© 2023. The Author(s).
Références
BMJ Open. 2020 Aug 26;10(8):e038178
pubmed: 32847918
Kardiol Pol. 2021;79(5):510-516
pubmed: 34125923
Eur J Cardiovasc Nurs. 2022 Aug 29;21(6):548-558
pubmed: 34935940
Heart Lung Circ. 2022 Nov;31(11):1504-1512
pubmed: 35987722
Eur J Prev Cardiol. 2020 Jun;27(9):912-928
pubmed: 31581808
Pharmacoeconomics. 2018 Feb;36(2):239-252
pubmed: 29273843
Neth Heart J. 2020 Sep;28(9):443-451
pubmed: 32495296
Health Serv Insights. 2022 Apr 11;15:11786329221091038
pubmed: 35431555
Eur J Cardiovasc Nurs. 2019 Apr;18(4):260-271
pubmed: 30667278
BMC Health Serv Res. 2022 Feb 28;22(1):267
pubmed: 35227258
Med J Aust. 2003 Oct 6;179(7):341-5
pubmed: 14503895
Curr Cardiol Rep. 2021 Jul 16;23(9):118
pubmed: 34269894
Eur J Prev Cardiol. 2016 May;23(7):674-82
pubmed: 26289723
Eur Heart J Digit Health. 2020 Nov 23;1(1):20-29
pubmed: 37056294
Arch Intern Med. 2003 Dec 8-22;163(22):2775-83
pubmed: 14662633
Heart. 2014 Nov;100(22):1770-9
pubmed: 24973083
Eur Heart J. 2021 Sep 7;42(34):3227-3337
pubmed: 34458905
Eur J Prev Cardiol. 2019 Jul;26(11):1131-1146
pubmed: 30782007
Heart. 2018 Sep;104(17):1403-1410
pubmed: 29654096
Circulation. 2018 May 1;137(18):1899-1908
pubmed: 29305529
J Womens Health (Larchmt). 2017 Aug;26(8):849-859
pubmed: 28388314
BMJ Open. 2022 Feb 16;12(2):e054558
pubmed: 35173003
Heart. 2016 Aug 1;102(15):1183-92
pubmed: 26936337
J Gen Intern Med. 2022 Aug;37(11):2845-2848
pubmed: 35352272
JAMA Netw Open. 2021 Dec 1;4(12):e2136652
pubmed: 34854907
Heart Lung Circ. 2020 Mar;29(3):475-482
pubmed: 31072769
Physiother Theory Pract. 2021 Jan;37(1):158-168
pubmed: 31155986
Prog Cardiovasc Dis. 2022 Jan-Feb;70:175-182
pubmed: 34958846
Heart Lung Circ. 2019 Dec;28(12):1795-1803
pubmed: 30528811
BMJ Open. 2019 Dec 2;9(12):e032279
pubmed: 31796485
Cochrane Database Syst Rev. 2021 Nov 6;11:CD001800
pubmed: 34741536
Eur J Prev Cardiol. 2017 Nov;24(16):1708-1717
pubmed: 28925749
J Am Heart Assoc. 2021 Oct 19;10(20):e021356
pubmed: 34612055
Open Heart. 2016 Feb 23;3(1):e000374
pubmed: 27127639
Heart. 2019 Jan;105(2):122-129
pubmed: 30150328
J Cardiopulm Rehabil Prev. 2008 Nov-Dec;28(6):380-5
pubmed: 19008692
Clin Med Insights Cardiol. 2017 Jun 12;11:1179546817710028
pubmed: 28638244
Eur Heart J Digit Health. 2021 Oct 22;3(1):67-76
pubmed: 36713992
Eur J Prev Cardiol. 2015 Jun;22(6):701-9
pubmed: 24817694
Am Heart J. 2009 Nov;158(5):852-9
pubmed: 19853708
Cardiovasc Diabetol. 2021 May 13;20(1):106
pubmed: 33985509
Open Heart. 2017 Jul 28;4(2):e000623
pubmed: 28878950