Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation
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Since the late 1990s, 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.
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.
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 € (±318; p < 0.001) compared to outpatient rehabilitation (2,016 € ± 354 € vs. 1,416 € ± 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 € (p = 0.102) and adjusted difference in effects at 0.018 quality-adjusted life years (QALYs) (n.s.) in favor of outpatient treatment.
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.
KeywordsCardiac rehabilitation Cost-effectiveness Quality of life Comprehensive cohort design Health-care cost EQ-5D Propensity score
This study was supported by the German pension insurance and the German Ministry of Research and Education, Grant number: 02 7 06 and 01GD0108. The authors thank Ms. Gertrud Feike and Ms. Eva Schlumpberger for their technical support of this study.
Conflict of interest statement
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