Key result
Measuring the ankle-brachial index if cardiac rehabilitation fails, followed by diagnostic work-up and revascularization for peripheral arterial disease if needed, is potentially cost-effective with an ICER of $44,251 per QALY gained.
Why the study?
Does ABI measurement and PAD revascularization improve cost-effectiveness in CAD patients undergoing cardiac rehabilitation?
Does ABI measurement and PAD revascularization improve cost-effectiveness in CAD patients undergoing cardiac rehabilitation?
ABI measurement if cardiac rehabilitation fails, followed by diagnostic work-up and revascularization for PAD if needed, is potentially cost-effective compared to cardiac rehabilitation alone in CAD patients.
OBJECTIVE: Peripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD) undergoing cardiac rehabilitation. DATA SOURCES: Best-available evidence was retrieved from literature and combined with primary data from 231 patients. METHODS: We developed a markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI) if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs), life-time costs (US $), incremental cost-effectiveness ratios (ICER), and gain in net health benefits (NHB) in QALY equivalents were calculated. A threshold willingness-to-pay of $75,000 was used. RESULTS: ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44,251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: -0.17, 0.29) at a threshold willingness-to-pay of $75,000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30,246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:-0.24, 0.46) compared to current practice. The results were robust for other different input parameters. CONCLUSION: ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.
No takes yet. Share an insight, caveat, or question.
Spronk et al. (2008) studied Coronary artery disease (n=231). Ankle-brachial index measurement if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed vs. Cardiac rehabilitation only was evaluated on Incremental cost-effectiveness ratio (ICER) and incremental Net Health Benefit (NHB) (Incremental NHB 0.03 QALYs, 95% CI -0.17 to 0.29). Measuring the ankle-brachial index if cardiac rehabilitation fails, followed by diagnostic work-up and revascularization for peripheral arterial disease if needed, is potentially cost-effective with an ICER of $44,251 per QALY gained.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: