Economic Evaluation of Alternative Cardiac Rehabilitation Programmes Compared to Centre-based Cardiac Rehabilitation Programmes - A Systematic Review

Aims Traditional centre-based cardiac rehabilitation (CBCR) has several drawbacks, including high costs, limited accessibility, and low utilisation rates. As a result, alternative cardiac rehabilitation programmes (ACRPs), such as home-based rehabilitation and telerehabilitation have been developed. This systematic review aims to synthesise existing evidence on the economic evaluation of ACRPs compared to CBCR. Methods We searched databases of MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and EconLit, as well as trials registers of Clinicaltrials.gov, International Clinical Trials Registry Platform, and EU Clinical Trials Register. The last search date was 20 March 2025. We included randomised controlled trials that directly compared ACRP with CBCR in terms of cost and effectiveness. Study quality was assessed using the Cochrane Risk of Bias tool and the Drummond 10-item checklist. Both qualitative and quantitative syntheses were conducted, with random-effects models applied in the meta-analysis. Results Thirteen studies met the inclusion criteria, comprising 2,040 participants. Meta-analysis showed a non-significant trend favouring CBCR over ACRP for EQ-5D (SMD = -0.32; 95% CI: -0.71 to 0.06; I² = 79%). For QALY, there was no difference between ACRP and CBCR (SMD = -0.02; 95% CI: -0.19 to 0.15; I² = 0). Ten of the thirteen studies reported lower costs for ACRP compared with traditional CBCR. Three of five economic evaluations found ACRP to be cost-effective. Conclusion ACRPs demonstrate cost-effectiveness comparable to traditional CBCR. This review highlights the potential of ACRPs such as home-based rehabilitation and telerehabilitation as solutions for broader implementation in CR practice.