Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands.
Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Capri Cardiac Rehabilitation, Rotterdam, the Netherlands.
Arch Phys Med Rehabil. 2023 Jun;104(6):855-862. doi: 10.1016/j.apmr.2023.02.005. Epub 2023 Mar 1.
To assess the cost-effectiveness of a cardiac rehabilitation (CR) program specifically designed for cardiac patients with obesity vs standard CR.
Cost-effectiveness analysis based on observations in a randomized controlled trial.
Three regional CR centers in the Netherlands.
Cardiac patients (N=201) with obesity (BMI≥30 kg/m) referred to CR.
Participants were randomized to a CR program specifically designed for patients with obesity (OPTICARE XL; N=102) or standard CR. OPTICARE XL included aerobic and strength exercise and behavioral coaching on diet and physical activity during 12 weeks, followed by a 9-month after-care program with "booster" educational sessions. Standard CR consisted of a 6- to 12-week aerobic exercise program, supplemented with cardiovascular lifestyle education.
An economic evaluation, with an 18-month time horizon, in terms of quality-adjusted life years (QALYs) and costs from the societal perspective was performed. Costs were reported in 2020 Euros, discounted at a 4% annual rate, and health effects were discounted at a 1.5% annual rate.
OPTICARE XL CR and standard CR resulted in comparable health gain per patient (0.958 vs 0.965 QALYs, respectively; P=.96). Overall, OPTICARE XL CR saved costs (-€4542) compared with the standard CR group. The direct costs for OPTICARE XL CR were higher than for standard CR (€10,712 vs €9951), whereas indirect costs were lower (€51,789 vs €57,092), but these differences were not significant.
This economic evaluation showed no differences between OPTICARE XL CR and standard CR in health effects and costs in cardiac patients with obesity.
评估专门为肥胖心脏病患者设计的心脏康复（CR）计划与标准 CR 的成本效益。
基于随机对照试验观察的成本效益分析。
荷兰的三个区域 CR 中心。
肥胖（BMI≥30kg/m）的心脏病患者（N=201）被转诊至 CR。
参与者被随机分配到专门为肥胖患者设计的 CR 计划（OPTICARE XL；N=102）或标准 CR。OPTICARE XL 包括有氧运动和力量训练以及行为指导，内容涉及饮食和身体活动，为期 12 周，之后是为期 9 个月的随访计划，其中包括“助推”教育课程。标准 CR 由 6-12 周的有氧运动计划组成，辅以心血管生活方式教育。
从社会角度进行了为期 18 个月的经济评估，以质量调整生命年（QALYs）和成本为指标。成本以 2020 年欧元报告，按 4%的年贴现率贴现，健康影响按 1.5%的年贴现率贴现。
OPTICARE XL CR 和标准 CR 对每个患者的健康收益相当（分别为 0.958 和 0.965 QALYs；P=.96）。总体而言，与标准 CR 组相比，OPTICARE XL CR 节省了成本（-€4542）。OPTICARE XL CR 的直接成本高于标准 CR（€10712 比 €9951），而间接成本较低（€51789 比 €57092），但这些差异并不显著。
这项经济评估表明，在肥胖心脏病患者中，OPTICARE XL CR 与标准 CR 在健康效果和成本方面没有差异。
