Cost-Effectiveness and Budget Impact Analysis of a Cardiac Rehabilitation Model of Care for Patients in Rural and Remote Communities

AIM: We aimed to assess the cost-effectiveness and funding implications of implementing the Country Heart Attack Prevention (CHAP) Project model of cardiac rehabilitation for patients in rural and remote areas. METHODS: A decision analytic model was designed to evaluate 12-month cardiac rehabilitation attendance and completion as the primary measures of effectiveness with emergency department (ED) visits and readmission as secondary outcomes. Effectiveness data were obtained from a linked dataset of hospital admissions, cardiac rehabilitation referral and attendance. Costs were calculated based on the Australian Refined Diagnosis-Related Groups version 10 and weighted by length of stay, reported in 2023 Australian dollars. The analysis was conducted from a healthcare provider perspective. The incremental cost effectiveness ratio (ICER) was calculated. Uncertainty in the ICER result was explored using probabilistic sensitivity analysis. A budget impact analysis estimated the financial benefit of implementing the model over 5 years for individuals who are eligible for CR in South Australia (SA). RESULTS: There were 1, 913 patients each in the intervention (CHAP) and usual care cohorts. CR attendance, ED visits and re-admissions through CHAP were comparable to usual care but more costly. CR completion through CHAP was less costly and more effective (costs: 6, 542 vs 8, 689; completions: 77. 1% vs 57. 5%). The CHAP model was not cost-effective for attendance, prevention of ED visit or CV mortality but was cost-effective for completion of CR with an ICER of -10, 735/completion and 94% probability of being cost-effective at a willingness to pay threshold of 50, 000/completion. Uptake of the CHAP model for the delivery of cardiac rehabilitation in SA would result in a cost reduction ranging from 2 million at 20% uptake to 10 million if all patients attending cardiac rehabilitation completed the program. CONCLUSIONS: The CHAP model of care, involving a combination of face-to-face, telephone, web-based and hybrid delivery for cardiac rehabilitation, provided a less costly and more effective alternative for individuals who completed cardiac rehabilitation. Attendance to cardiac rehabilitation under CHAP was similar to usual care, but more ED visits and CV mortality were observed with CHAP. The budget impact analysis demonstrated that adapting the CHAP model for cardiac rehabilitation results in significant savings to the healthcare system if the individuals attending cardiac rehabilitation complete the program.