Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK.
Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Centre for Sport Exercise & Life Sciences, Institute of Health & Well-being, Coventry University, UK.
Arch Phys Med Rehabil. 2024 Apr;105(4):639-646. doi: 10.1016/j.apmr.2023.09.005. Epub 2023 Sep 18.
To perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared with moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR).
Secondary cost-effectiveness analysis of a prospective, assessor-blind, parallel group, multi-center RCT.
Six outpatient National Health Service cardiac rehabilitation centers in England and Wales, UK.
382 participants with CAD (N=382).
Participants were randomized to twice-weekly usual care (n=195) or HIIT (n=187) for 8 weeks. Usual care was moderate intensity continuous exercise (60%-80% maximum capacity, MISS), while HIIT consisted of 10 × 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery.
We conducted a cost-effectiveness analysis of the HIIT or MISS UK trial. Health related quality of life was measured with the EQ-5D-5L to estimate quality-adjusted life years (QALYs). Costs were estimated with health service resource use and intervention delivery costs. Cost-utility analysis measured the incremental cost-effectiveness ratio (ICER). Bootstrapping assessed the probability of HIIT being cost-effective according to the UK National Institute for Health and Care Excellence (NICE) threshold value (£20,000 per QALY). Missing data were imputed. Uncertainty was estimated using probabilistic sensitivity analysis. Assumptions were tested using univariate/1-way sensitivity analysis.
124 (HIIT, n=59; MISS, n=65) participants completed questionnaires at baseline, 8 weeks, and 12 months. Mean combined health care use and delivery cost was £676 per participant for HIIT, and £653 for MISS. QALY changes were 0.003 and -0.013, respectively. For complete cases, the ICER was £1448 per QALY for HIIT compared with MISS. At a willingness-to-pay threshold of £20,000 per QALY, the probability of HIIT being cost-effective was 96% (95% CI, 0.90 to 0.95).
For people with CAD attending CR, HIIT was cost-effective compared with MISS. These findings are important to policy makers, commissioners, and service providers across the health care sector.
在参加心脏康复（CR）的冠心病（CAD）患者中，对高强度间歇训练（HIIT）与中等强度稳态（MISS）训练进行成本效益分析。
前瞻性、评估者盲法、平行组、多中心 RCT 的二次成本效益分析。
英国英格兰和威尔士的 6 个门诊国家卫生服务心脏康复中心。
382 名 CAD 患者（N=382）。
参与者被随机分配到每周两次的常规护理（n=195）或 HIIT（n=187），为期 8 周。常规护理是中等强度持续运动（最大能力的 60%-80%，MISS），而 HIIT 由 10 次 1 分钟的剧烈运动间隔组成（>85%最大能力），穿插 1 分钟恢复期。
我们对 HIIT 或 MISS UK 试验进行了成本效益分析。使用 EQ-5D-5L 测量健康相关的生活质量，以估计质量调整生命年（QALYs）。使用健康服务资源使用和干预交付成本来估计成本。成本效益分析衡量增量成本效益比（ICER）。Bootstrapping 根据英国国家卫生与保健卓越研究所（NICE）的阈值（每 QALY 20000 英镑）评估 HIIT 的成本效益概率。对缺失数据进行了插补。使用概率敏感性分析估计不确定性。使用单变量/1 -way 敏感性分析测试假设。
124 名（HIIT，n=59；MISS，n=65）参与者在基线、8 周和 12 个月时完成了问卷。HIIT 组每位参与者的综合医疗保健使用和交付成本平均为 676 英镑，MISS 组为 653 英镑。QALY 变化分别为 0.003 和-0.013。对于完整病例，HIIT 与 MISS 相比，ICER 为每 QALY 1448 英镑。在每 QALY 20000 英镑的意愿支付阈值下，HIIT 的成本效益概率为 96%（95%CI，0.90 至 0.95）。
对于参加 CR 的 CAD 患者，与 MISS 相比，HIIT 具有成本效益。这些发现对医疗保健领域的政策制定者、委托人和服务提供者都很重要。
