Cardiology Division, Hospital de Clínicas de Porto Alegre, Department of Medicine and Graduate Program of Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Value Health. 2011 Jul-Aug;14(5 Suppl 1):S100-7. doi: 10.1016/j.jval.2011.05.006.
Exercise therapy in heart failure (HF) patients is considered safe and has demonstrated modest reduction in hospitalization rates and death in recent trials. Previous cost-effectiveness analysis described favorable results considering long-term supervised exercise intervention and significant effectiveness of exercise therapy; however, these evidences are now no longer supported. To evaluate the cost-effectiveness of supervised exercise therapy in HF patients under the perspective of the Brazilian Public Healthcare System.
We developed a Markov model to evaluate the incremental cost-effectiveness ratio of supervised exercise therapy compared to standard treatment in patients with New York Heart Association HF class II and III. Effectiveness was evaluated in quality-adjusted life years in a 10-year time horizon. We searched PUBMED for published clinical trials to estimate effectiveness, mortality, hospitalization, and utilities data. Treatment costs were obtained from published cohort updated to 2008 values. Exercise therapy intervention costs were obtained from a rehabilitation center. Model robustness was assessed through Monte Carlo simulation and sensitivity analysis. Cost were expressed as international dollars, applying the purchasing-power-parity conversion rate.
Exercise therapy showed small reduction in hospitalization and mortality at a low cost, an incremental cost-effectiveness ratio of Int$26,462/quality-adjusted life year. Results were more sensitive to exercise therapy costs, standard treatment total costs, exercise therapy effectiveness, and medications costs. Considering a willingness-to-pay of Int$27,500, 55% of the trials fell below this value in the Monte Carlo simulation.
In a Brazilian scenario, exercise therapy shows reasonable cost-effectiveness ratio, despite current evidence of limited benefit of this intervention.
心力衰竭（HF）患者的运动疗法被认为是安全的，并且在最近的试验中已证明其可适度降低住院率和死亡率。以前的成本效益分析描述了考虑长期监督运动干预和运动疗法的显著效果的有利结果；但是，这些证据现在不再得到支持。从巴西公共医疗保健系统的角度评估心力衰竭患者监督运动疗法的成本效益。
我们开发了一个马尔可夫模型，以评估与标准治疗相比，监督运动疗法在纽约心脏协会 HF Ⅱ级和Ⅲ级患者中的增量成本效益比。在 10 年的时间范围内，通过质量调整生命年来评估疗效。我们在 PUBMED 上搜索已发表的临床试验，以估算疗效，死亡率，住院率和效用数据。从更新至 2008 年价值的已发表队列中获得治疗费用。从康复中心获得运动疗法干预费用。通过蒙特卡洛模拟和敏感性分析评估模型的稳健性。费用以国际元表示，应用购买力平价换算率。
运动疗法在低费用下可减少住院和死亡率，增量成本效益比为每质量调整生命年 26462 国际元。结果对运动疗法费用，标准治疗总成本，运动疗法疗效和药物费用更为敏感。考虑到愿意支付 27500 国际元，在蒙特卡洛模拟中，55％的试验低于该值。
在巴西情况下，尽管目前该干预措施的益处有限，但运动疗法仍具有合理的成本效益比。
