Key result
The learning and coping programme did not significantly differ from standard cardiac rehabilitation in QALYs (difference -0.006; 95% CI -0.053 to 0.042) or total societal costs over 3 years.
Why the study?
To investigate the cost-utility of a 'learning and coping' patient education programme designed to enhance cardiac rehabilitation adherence compared with standard cardiac rehabilitation.
Does the 'learning and coping' education programme improve cost-utility compared to standard education in patients undergoing cardiac rehabilitation?
RCT (n=825)
Randomized
Yes
Does the 'learning and coping' education programme improve cost-utility compared to standard education in patients undergoing cardiac rehabilitation?
Mean Difference: -0.006 (95% CI -0.053–0.042)
The 'learning and coping' education program in cardiac rehabilitation was not cost-effective overall compared to standard education, but showed potential cost-effectiveness in the heart failure subgroup.
LC-programme may be cost-effective in Danish CR; leaves open generalisability beyond this RCT setting.
Objectives: To enhance adherence to cardiac rehabilitation (CR), a patient education programme called 'learning and coping' (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost-utility of the LC-programme compared with the standard CR-programme. Methods: 825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3 years.A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves. Results: No statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95% CI -3828 to 12 533) or in QALY (-0.006; 95% CI -0.053 to 0.042). At a threshold of 40 000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%. Conclusions: While the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.
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Dehbarez et al. (2020) conducted an RCT in Ischaemic heart disease or heart failure (n=825). Learning and coping (LC-programme) vs. Standard cardiac rehabilitation programme was evaluated on Quality-adjusted life years (QALY) (MD -0.006, 95% CI -0.053 to 0.042). The learning and coping programme did not significantly differ from standard cardiac rehabilitation in QALYs (difference -0.006; 95% CI -0.053 to 0.042) or total societal costs over 3 years.
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