Cost-Effectiveness of Cardiac Rehabilitation After Myocardial Infarction

BACKGROUND: Cardiac rehabilitation is commonly prescribed after myocardial infarction (MI) to coordinate exercise training and secondary preventive services. Cost-effectiveness analysis allows the quantitative comparison of the relative economic worth of cardiac rehabilitation in relation to other common interventions. METHODS: The cost-effectiveness of cardiac rehabilitation, in dollars per year of life saved (/YLS), was calculated by combining published results of randomized trials of cardiac rehabilitation on mortality rates, epidemiologic studies of long-term survival in the overall postinfarction population, and studies of patient charges for rehabilitation services and averted medical expenses for hospitalizations after rehabilitation. RESULTS: Cardiac rehabilitation participants experienced an incremental life expectancy of 0. 202 years during a 15-year period. In 1988, the average cost of rehabilitation and exercise testing was 1, 485, partially offset by averted cardiac rehospitalizations of 850 per patient. A cost-effectiveness value of 2, 130 /YLS was determined for the late 1980s, projected to a value of 4, 950 /YLS for 1995. A sensitivity analysis supports the study results. CONCLUSIONS: Compared with other post-MI treatment interventions, cardiac rehabilitation is more cost-effective than thrombolytic therapy, coronary bypass surgery, and cholesterol lowering drugs, though less cost-effective than smoking cessation programs. Cardiac rehabilitation should stand alongside these therapies as standard of care in the post-MI setting.