Papadakis Sophia, Reid Robert D, Coyle Doug, Beaton Louise, Angus Douglas, Oldridge Neil
MINTO Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Eur J Cardiovasc Prev Rehabil. 2008 Jun;15(3):347-53. doi: 10.1097/HJR.0b013e3282f5ffab.
Little is known about the relative cost-effectiveness of different secondary prevention cardiac rehabilitation (CR) program designs or how cost-effectiveness is influenced by patient clinical and demographic characteristics. The purpose of the study was (i) to evaluate the incremental cost-effectiveness of a standard 3-month CR program (SCR) versus a program distributed over 12 months (distributed CR, DCR); and (ii) to determine the effect of patient demographic characteristics (cardiac risk, cardiac diagnosis, sex) on incremental cost-effectiveness.
A two group cost-effectiveness analysis was conducted alongside a randomized controlled trial. Patients with coronary artery disease (mean age=58 years, SD+/-10) were randomized to either SCR (n=196) or DCR (n=196) and followed for 24 months. Program delivery costs, cardiac healthcare use, morbidity, mortality, and quality-adjusted life years were assessed. Cost-effectiveness was evaluated with incremental cost-utility analysis.
In the pooled analysis, we found the probability of SCR being more cost-effective than DCR was 63-67%. The subanalysis found SCR to be the more cost-effective intervention for patients at high risk, patients with previous coronary artery bypass graft and for male patients. The DCR program was more cost-effective for patients with lower risk of disease progression and for female patients.
Differences were noted in the cost-effectiveness of CR models based on cardiac risk level, reason for referral, and demographic characteristics. Our results suggest improved cost-effectiveness may be gained by triaging patients to different CR intervention models, however, further investigation is required.
对于不同二级预防心脏康复（CR）项目设计的相对成本效益，或者成本效益如何受到患者临床和人口统计学特征的影响，人们了解甚少。本研究的目的是：（i）评估标准3个月CR项目（SCR）与为期12个月的项目（分布式CR，DCR）的增量成本效益；以及（ii）确定患者人口统计学特征（心脏风险、心脏诊断、性别）对增量成本效益的影响。
在一项随机对照试验的同时进行了两组成本效益分析。将冠心病患者（平均年龄 = 58岁，标准差±10）随机分为SCR组（n = 196）或DCR组（n = 196），并随访24个月。评估项目实施成本、心脏保健使用情况、发病率、死亡率和质量调整生命年。采用增量成本效用分析评估成本效益。
在汇总分析中，我们发现SCR比DCR更具成本效益的概率为63 - 67%。亚组分析发现，SCR对高危患者、既往有冠状动脉旁路移植术的患者和男性患者是更具成本效益的干预措施。DCR项目对疾病进展风险较低的患者和女性患者更具成本效益。
基于心脏风险水平、转诊原因和人口统计学特征，CR模型的成本效益存在差异。我们的结果表明，通过将患者分流到不同的CR干预模型可能会提高成本效益，然而，还需要进一步研究。
