Cost-effectiveness of digitally enabled telerehabilitation: advancing cardiac rehabilitation

Introduction The use of digital technologies in cardiac rehabilitation (CR) programs for heart disease is associated with improvements in outcomes. However, widespread adoption of digital CR programs into clinical practice is slow and limited by insufficient cost-effectiveness evidence. This study evaluates the cost-effectiveness of a nationally implemented, digitally enabled telerehabilitation (DeCR) program for coronary artery disease (CAD) patients. Purpose To assess whether a DeCR program is cost-effective compared with face-to-face CR (F2F-CR) within an Australian private healthcare setting. Methods We conducted a cost-effectiveness analysis from the perspective of the Australian healthcare system and private insurers using a Markov model to estimate quality-adjusted life years (QALYs) and healthcare costs for DeCR compared to F2F-CR. Post-hospitalisation CAD patients were recruited nationwide into the DeCR program through a health insurer and received 8 weeks of telehealth consultations supported by a mobile app. Data for the F2F-CR group was obtained from hospital claims and existing literature. Costs for both groups were sourced from private health insurance claims, quality of life (QoL) scores were derived from study data (DeCR) and literature (F2F-CR), and transition probabilities from literature. Intervention costs, rehospitalisation costs, and EQ-5D-derived QoL utility scores informed the incremental cost-effectiveness ratio (ICER). We modelled a five-year time horizon with monthly cycles. Costs were expressed in 2021 Australian dollars and discounted at 3% annually. We compared ICERs across interventions with a willingness-to-pay (WTP) threshold of $50,000 per QALY. Results Of the 173 patients in the study (DeCR: 88, F2F-CR: 85), 69% were aged 65+, 23% lived in regional/rural areas, 75% were male, 61% had a Charlson Comorbidity Index (CCI) > 1, and 37% had multivessel CAD. The DeCR intervention was an efficient strategy, generating 10.80 QALYs at an incremental cost of $13,388, with an ICER of $8,648 per QALY gained—well within the WTP threshold. F2F-CR incurred a lower cost at $157,634 and yielded 9.25 QALYs. Conclusion DeCR demonstrates a cost-effective strategy for CAD patients. Its implementation in clinical practice may be justified to expand CR options and improve accessibility.