Cardiac Rehabilitation for Persons with Stroke: A Cost-Effectiveness Analysis.

OBJECTIVE

To investigate the cost-effectiveness of a cardiac rehabilitation program in individuals with stroke compared with customary care.

DESIGN

A Markov model was created using a 30-year time horizon, with cycle lengths of 1 year to determine the effectiveness and cost-effectiveness of a cardiac rehabilitation program in persons with stroke. Input parameters were based on recently published literature. Health states were defined as degree of disability evaluated by the modified Rankin scale score. Costs were based on recent cost-effectiveness analyses and inflated to 2024 US Dollars using the medical care component of the US Consumer Price Index.

SETTING

Outpatient ambulatory setting.

PARTICIPANTS

Persons with mild disability after ischemic stroke.

INTERVENTION

A model comparing cardiac rehabilitation versus usual care was created.

MAIN MEASURES

Quality-adjusted life years (QALYs) were used to measure the effectiveness of cardiac rehabilitation versus usual care. The cost-effectiveness of cardiac rehabilitation versus usual care was compared with respect to incremental costs, incremental effectiveness, and incremental cost-effectiveness ratios (ICERs).

RESULTS

Cardiac rehabilitation was the superior strategy, resulting in higher incremental effectiveness of 3.28 QALY at an increased incremental cost of $5704. The ICER was $1740/QALY. A two-way sensitivity analysis of these variables had no change, with cardiac rehab remaining the optimal strategy.

CONCLUSIONS

While numerous studies and systematic analyses have reported compelling evidence of the clinical benefits of cardiac rehabilitation for patients with stroke, the current study contributes to the existing body of literature, demonstrating that cardiac rehabilitation is also cost-effective in the stroke population.