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Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation

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Abstract

Background

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.

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 € (±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.

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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Notes

  1. The model included sociodemographic variables, distance from outpatient rehabilitation center and baseline score of QOL, as additional clinical characteristics showed no improvement of the model.

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Acknowledgments

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

None.

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Authors and Affiliations

  1. Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, P.O.Box 1129, 85758, Neuherberg, Germany

    Bernd Schweikert & Reiner Leidl

  2. Health Economics and Outcomes, i3 innovus, Munich, Germany

    Bernd Schweikert

  3. Klinik Schwabenland, Isny-Neutrauchburg, Germany

    Harry Hahmann

  4. Section of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany

    Jürgen M. Steinacker & Yufei Liu

  5. Department of Internal Medicine II, Cardiology, Ulm University Medical Center, Ulm, Germany

    Armin Imhof & Wolfgang Koenig

  6. Institute of Biometrics, Ulm University, Ulm, Germany

    Rainer Muche

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  1. Bernd Schweikert
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Correspondence to Bernd Schweikert.

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Schweikert, B., Hahmann, H., Steinacker, J.M. et al. Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation. Clin Res Cardiol 98, 787–795 (2009). https://doi.org/10.1007/s00392-009-0081-6

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  • DOI: https://doi.org/10.1007/s00392-009-0081-6

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