Home-based Cardiac Rehabilitation Versus Hospital-Based Rehabilitation: A Cost Effectiveness Analysis

Int J Cardiol. 2007 Jul 10;119(2):196-201. doi: 10.1016/j.ijcard.2006.07.218. Epub 2006 Nov 7.

Abstract

Background: Home-based cardiac rehabilitation offers an alternative to traditional, hospital-based cardiac rehabilitation.

Aim: To compare the cost effectiveness of home-based cardiac rehabilitation and hospital-based cardiac rehabilitation.

Methods: 104 patients with an uncomplicated acute myocardial infarction and without major comorbidity were randomized to receive home-based rehabilitation (n=60) i.e. nurse facilitated, self-help package of 6 weeks' duration (the Heart Manual) or hospital-based rehabilitation for 8-10 weeks (n=44). Complete economic data were available in 80 patients (48 who received home-based rehabilitation and 32 who received hospital-based rehabilitation). Healthcare costs, patient costs, and quality of life (EQ-5D4.13) were assessed over the 9 months of the study.

Results: The cost of running the home-based rehabilitation programme was slightly lower than that of the hospital-based programme (mean (95% confidence interval) difference - 30 pounds sterling (- 45 pounds sterling to - 12 pounds sterling) [-44 euro, -67 euro to -18 euro] per patient. The cost difference was largely the result of reduced personnel costs. Over the 9 months of the study, no significant difference was seen between the two groups in overall healthcare costs (78 pounds sterling, - 1102 pounds sterling to 1191 pounds sterling [-115 euro, -1631 euro to -1763 euro] per patient) or quality adjusted life-years (-0.06 (-0.15 to 0.02)). The lack of significant difference between home-based rehabilitation and hospital-based rehabilitation did not alter when different costs and different methods of analysis were used.

Conclusions: The health gain and total healthcare costs of the present hospital-based and home-based cardiac rehabilitation programmes for patients after myocardial infarction appear to be similar. These initial results require affirmation by further economic evaluations of cardiac rehabilitation in different settings.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • England
  • Female
  • Health Status Indicators
  • Home Care Services, Hospital-Based / economics*
  • Hospitalization / economics*
  • Humans
  • Logistic Models
  • Male
  • Myocardial Infarction / rehabilitation*
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Referral and Consultation / economics