Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome

Scand J Med Sci Sports. 2017 Nov;27(11):1395-1403. doi: 10.1111/sms.12738. Epub 2016 Aug 19.


Health care decision-making requires evidence of the cost-effectiveness of medical therapies. We evaluated the cost-effectiveness of exercise-based cardiac rehabilitation (ECR) implemented according to guidelines. All the patients (n = 204) had experienced a recent acute coronary syndrome and were randomized to a 1-year ECR (n = 109) or usual care (UC) group (n = 95). The patients' health-related quality of life was followed using the 15D instrument and health care costs were collected from electronic health registries. The cost-effectiveness of ECR was estimated based on intervention and health care costs and quality-adjusted life years (QALYs) gained. The total average cost per patient was lower in ECR than in UC. The incremental cost was divided by the baseline-adjusted incremental QALYs (0.045), yielding an incremental cost-effectiveness ratio of -€24511/QALYs. A combined endpoint of mortality, recurrent coronary event, or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC (HR 3.9, 95% CI 1.4-10.6, P = 0.004, relative risk reduction 73%, number needed to treat eight). ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events. These results are useful for decision-making when planning optimal utilization of resources in Finnish health care.

Keywords: Coronary heart disease; cost-effectiveness; exercise training; rehabilitation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acute Coronary Syndrome / economics
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Cardiac Rehabilitation / economics*
  • Cardiac Rehabilitation / methods
  • Cost-Benefit Analysis
  • Exercise Therapy*
  • Female
  • Health Care Costs
  • Humans
  • Male
  • Middle Aged
  • Quality of Life
  • Quality-Adjusted Life Years