Skip to main content

Advertisement

SpringerLink
Log in

Economic Evaluation of Exercise Training in Patients with Pulmonary Hypertension

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

Exercise training as an add-on to medical therapy has been shown to improve exercise capacity, quality of life, and possibly prognosis in patients with pulmonary hypertension (PH). The purpose of this study was to analyze the impact of exercise training on healthcare costs in PH.

Methods

Estimated healthcare costs have been compared between patients with severe PH under optimized medical therapy only (control group) versus patients who received exercise training as an add-on to medical therapy (training group). Cost-analysis included a cost-estimation model of costs for baseline and follow-up visits and all PH-related healthcare events that occurred within the follow-up period. Time to clinical worsening and survival were assessed by clinical records, phone, and/or control visits.

Results

At baseline, the training (n = 58) and control group (n = 48) did not differ in age, gender, WHO-functional class, 6-min walking distance, hemodynamic parameters, or PH-targeted medication. During a follow-up of 24 ± 12 months, the training group had significantly better survival rates at 1 and 3 years and less worsening events (death, lung transplantation, hospitalization due to PH, new PAH-targeted medication) than the control group (15 vs. 25 events, p < 0.05), which also led to lower estimated healthcare costs of 657€ within a period of 2 years.

Conclusions

This is the first study to investigate the cost-effectiveness of exercise training in PH. Due to less worsening events within 2 years, healthcare costs were lower in patients performing exercise training as add-on to medical therapy than in patients with medical treatment only. Further prospective, randomized studies are needed to confirm these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Löwe B, Gräfe K, Ufer C, Kroenke K, Grünig E, Herzog W, Borst MM (2004) Anxiety and depression in patients with pulmonary hypertension. Psychosom Med 66:831–836

    Article  PubMed  Google Scholar 

  2. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 34:1219–1263

    Article  PubMed  Google Scholar 

  3. Hoeper MM, Huscher D, Ghofrani HA, Delcroix M, Distler O, Schweiger C, Grunig E, Staehler G, Rosenkranz S, Halank M, Held M, Grohé C, Lange TJ, Behr J, Klose H, Wilkens H, Filusch A, Germann M, Ewert R, Seyfarth HJ, Olsson KM, Opitz CF, Gaine SP, Vizza CD, Vonk-Noordegraaf A, Kaemmerer H, Gibbs JS, Pittrow D (2012) Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: results from the COMPERA registry. Int J Cardiol 68(2):871–880. doi:10.1016/j.ijcard.2012.10.026

    Google Scholar 

  4. Nickel N, Golpon H, Greer M, Knudsen L, Olsson K, Westerkamp V, Welte T, Hoeper MM (2012) The prognostic impact of follow-up assessments in patients with idiopathic pulmonary arterial hypertension. Eur Respir J 39:589–596

    Article  CAS  PubMed  Google Scholar 

  5. Chung L, Liu J, Parsons L, Hassoun PM, McGoon M, Badesch DB, Miller DP, Nicolls MR, Zamanian RT (2010) Characterization of connective tissue disease-associated pulmonary arterial hypertension from REVEAL: identifying systemic sclerosis as a unique phenotype. Chest 138:1383–1394

    Article  PubMed Central  PubMed  Google Scholar 

  6. Wilkens H, Grimminger F, Hoeper M, Stähler G, Ehlken B, Plesnila-Frank C, Berger K, Resch A, Ghofrani A (2010) Burden of pulmonary arterial hypertension in Germany. Respir Med 104:902–910

    Article  CAS  PubMed  Google Scholar 

  7. Reed SD, Whellan DJ, Li Y, Friedman JY, Ellis SJ, Piña IL, Settles SJ, Davidson-Ray L, Johnson JL, Cooper LS, O’Connor CM, Schulman KA, HF-ACTION Investigators (2010) Economic evaluation of the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized controlled trial: an exercise training study of patients with chronic heart failure. Circ Cardiovasc Qual Outcomes 3:374–381

    Article  PubMed Central  PubMed  Google Scholar 

  8. Halank M, Einsle F, Lehman S, Bremer H, Ewert R, Wilkens H, Meyer FJ, Grünig E, Seyfarth H-J, Kolditz M, Wieder G, Höffken G, Köllner V (2013) Exercise capacity affects quality of life in patients with pulmonary hypertension. Lung 91(4):337–343. doi:10.1007/s00408-013-9472-6

    Article  Google Scholar 

  9. Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winkler J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grünig E (2006) Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 114:1482–1489

    Article  PubMed  Google Scholar 

  10. Grünig E, Ehlken N, Ghofrani A, Staehler G, Meyer FJ, Juenger J, Opitz CF, Klose H, Wilkens H, Rosenkranz S, Olschewski H, Halank M (2011) Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration 81:394–401

    Article  PubMed  Google Scholar 

  11. Grünig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, Halank M, Fischer C, Seyfarth HJ, Klose H, Meyer A, Sorichter S, Wilkens H, Rosenkranz S, Opitz C, Leuchte H, Karger G, Speich R, Nagel C (2012) Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J 40:84–92

    Article  PubMed  Google Scholar 

  12. Becker-Grünig T, Klose H, Ehlken N, Lichtblau M, Nagel C, Fischer C, Gorenflo M, Tiede H, Schranz D, Hager A, Kaemmerer H, Miera O, Ulrich S, Speich R, Uiker S, Grünig E (2012) Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease. Int J Cardiol 168(1):375–381. doi:10.1016/j.ijcard.2012.09.036

    Article  PubMed  Google Scholar 

  13. Wensel R, Opitz CF, Anker SD, Winkler J, Höffken G, Kleber FX, Sharma R, Hummel M, Hetzer R, Ewert R (2002) Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation 106:319–324

    Article  PubMed  Google Scholar 

  14. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K (2000) Clinical correlates and prognostic significance of 6-min walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487–492

    Article  CAS  PubMed  Google Scholar 

  15. Weinstein MC, Stason WB (1976) Hypertension: a policy perspective. Harvard University Press, Cambridge, MA

    Book  Google Scholar 

  16. Klarman H, Francis J, Rosenthal G (1968) Cost-effectiveness analysis applied to the treatment of chronic renal disease. Med Care 6:48–54

    Article  Google Scholar 

  17. Chen YF, Jowett S, Barton P, Malottki K, Hyde C, Gibbs JS, Pepke-Zaba J, Fry-Smith A, Roberts J, Moore D (2009) Clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for pulmonary arterial hypertension within their licensed indications: a systematic review and economic evaluation. Health Technol Assess 13:1–320

    Article  PubMed  Google Scholar 

  18. Angalakuditi M, Edgell E, Beardsworth A, Buysman E, Bancroft T (2010) Treatment patterns and resource utilization and costs among patients with pulmonary arterial hypertension in the United States. J Med Econ 13:393–402

    Article  PubMed  Google Scholar 

  19. Kühr EM, Ribeiro RA, Rohde LE, Polanczyk CA (2011) Cost-effectiveness of supervised exercise therapy in heart failure patients. Value Health 14:S100–S107

    Article  PubMed  Google Scholar 

  20. Georgiou D, Chen Y, Appadoo S, Belardinelli R, Greene R, Parides MK, Glied S (2001) Cost-effectiveness analysis of long-term moderate exercise training in chronic heart failure. Am J Cardiol 87(984–988):A4

    Google Scholar 

  21. Sohn S, Helms TM, Pelleter JT, Müller A, Kröttinger AI, Schöffski O (2012) Costs and benefits of personalized healthcare for patients with chronic heart failure in the care and education program “Telemedicine for the Heart.”. Telemed J E Health 18:198–204

    Article  PubMed  Google Scholar 

  22. Hoeper MM, Markevych I, Spiekerkoetter E, Welte T, Niedermeyer J (2005) Goal-oriented treatment and combination therapy for pulmonary arterial hypertension. Eur Respir J 26:858–863

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank all patients who participated and the patient organization pulmonary hypertension e.V for their support. We are grateful and thank for the support of the clinic director Karl-Heinz Markmann and Dr. Nechwatal, all physicians, therapists, and physiotherapists of the Rehabilitation-Clinic Koenigstuhl Heidelberg, who took part in the rehabilitation program. The study was funded by a grant of Pfizer Pharma AG.

Conflict of interest

None.

Ethical Standards

All patients of the training group gave written, informed consent for this study, which was approved by the Ethics Committee of the University of Heidelberg. The retrospective data complies with the Declaration of Helsinki.

Author information

Authors and Affiliations

  1. Department of Pneumology, Thoraxclinic Heidelberg, Amalienstrasse 5, 69126, Heidelberg, Germany

    Nicola Ehlken & Ekkehard Grünig

  2. Mapi Consultancy Houten, Houten, The Netherlands

    Cora Verduyn

  3. University of Giessen and Marburg Lung Center (UGMLC), Marburg, Germany

    Henning Tiede

  4. Department of Cardiology, Clinic Löwenstein, Lowenstein, Germany

    Gerd Staehler

  5. Rehabilitation Clinic Königstuhl, Heidelberg, Germany

    Gabriele Karger & Robert Nechwatal

  6. Department of Cardiology, DRK Kliniken Berlin Köpenick, Berlin, Germany

    Christian F. Opitz

  7. Department of Pneumology, University of Hamburg, Hamburg, Germany

    Hans Klose & Heinrike Wilkens

  8. Department of Cardiology, University of Cologne, Cologne, Germany

    Stephan Rosenkranz

  9. Department of Pneumology, University of Dresden, Dresden, Germany

    Michael Halank

Authors
  1. Nicola Ehlken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cora Verduyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henning Tiede
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerd Staehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gabriele Karger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Nechwatal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian F. Opitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hans Klose
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Heinrike Wilkens
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stephan Rosenkranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Michael Halank
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ekkehard Grünig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ekkehard Grünig.

Additional information

Nicola Ehlken and Cora Verduyn have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ehlken, N., Verduyn, C., Tiede, H. et al. Economic Evaluation of Exercise Training in Patients with Pulmonary Hypertension. Lung 192, 359–366 (2014). https://doi.org/10.1007/s00408-014-9558-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-014-9558-9

Keywords

Search

Navigation