Home-based cardiac rehabilitation versus hospital-based rehabilitation:A cost effectiveness analysis

Abstract

Background: Home-based cardiac rehabilitation offers an alternative to traditional, hospital-based cardiac rehabilitation. Aim: To compare the cost effectiveness of home-based cardiac rehabilitation and hospital-based cardiac rehabilitation. Methods: 104 patients with an uncomplicated acute myocardial infarction and without major comorbidity were randomized to receive home-based rehabilitation (n = 60) i.e. nurse facilitated, self-help package of 6 weeks' duration (the Heart Manual) or hospital-based rehabilitation for 8-10 weeks (n = 44). Complete economic data were available in 80 patients (48 who received home-based rehabilitation and 32 who received hospital-based rehabilitation). Healthcare costs, patient costs, and quality of life (EQ-5D4.13) were assessed over the 9 months of the study. Results: The cost of running the home-based rehabilitation programme was slightly lower than that of the hospital-based programme (mean (95% confidence interval) difference - £30 (- £45 to - £12) [- €44, - €67 to - €18] per patient. The cost difference was largely the result of reduced personnel costs. Over the 9 months of the study, no significant difference was seen between the two groups in overall healthcare costs (£78, - £1102 to £1191 [- €115, - €1631 to - €1763] per patient) or quality adjusted life-years (- 0.06 (- 0.15 to 0.02)). The lack of significant difference between home-based rehabilitation and hospital-based rehabilitation did not alter when different costs and different methods of analysis were used. Conclusions: The health gain and total healthcare costs of the present hospital-based and home-based cardiac rehabilitation programmes for patients after myocardial infarction appear to be similar. These initial results require affirmation by further economic evaluations of cardiac rehabilitation in different settings.</p