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Open Access Green as soon as Postprint is submitted to ZB.
Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation.
Clin. Res. Cardiol. 98, 787-795 (2009)
BACKGROUND: Since the late 1990 s, cost pressure has led to a growing interest in outpatient rehabilitation in Germany where predominantly inpatient rehabilitation has been provided. Taking into account the feasibility of a randomized design, the aim of this study was to compare outpatient and inpatient cardiac rehabilitation from a societal perspective. METHOD: A comprehensive cohort design was applied. Costs during rehabilitation were measured using individual documentation of the rehabilitation centers. Economic end points were quality of life (EQ-5D), and total direct and indirect costs. A propensity score approach, integrated into a simultaneous regression framework for cost and effects, was used to control for selection bias. Bootstrap analysis was applied for assessing uncertainty in cost-effectiveness. RESULTS: A total of 163 patients were included in the study (112 inpatients, 51 outpatients). As randomization was chosen by only 2.5% of participants, the study had to be analyzed as an observational study. Direct costs during inpatient rehabilitation were significantly higher by 600 euro (+/-318; p < 0.001) compared to outpatient rehabilitation (2,016 euro +/- 354 euro vs. 1,416 euro +/- 315), while there was no significant difference in health-related quality of life. Over the 12-month follow-up period, adjusted costs difference in total cost was estimated at -2,895 euro (p = 0.102) and adjusted difference in effects at 0.018 quality-adjusted life years (QALYs) (n.s.) in favor of outpatient treatment. CONCLUSION: The ratio of mean cost over mean effect difference (incremental cost-effectiveness ratio) indicates dominance of outpatient rehabilitation, but at a considerable statistical uncertainty. However, outpatient rehabilitation cannot be rejected from an economic perspective.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Cardiac rehabilitation; Cost-effectiveness; Quality of life; Comprehensive cohort design; Health-care cost; EQ-5D; Propensity score
ISSN (print) / ISBN
1861-0684
e-ISSN
1861-0692
Journal
Clinical Research in Cardiology
Quellenangaben
Volume: 98,
Issue: 12,
Pages: 787-795
Publisher
Springer
Non-patent literature
Publications
Reviewing status
Peer reviewed