Cost-Effectiveness in Cardiac Rehabilitation

With health care costs exceeding $500 billion in the United States in 1990, efforts to contain costs will continue to intensify. More than ever before, new and established therapies will be scrutinized for medical benefit and cost. Prospective payment by diagnosis-related groups (DRG) for inpatients insured by Medicare was the first step by the federal government to control costs. More federal controls on outpatient services can be expected, with private insurers to follow. These economic pressures have stimulated increasing interest in cost-efective care. Cardiac rehabilitation services have come under increased scrutiny, and conflicting guidelines have been published regarding their applicability. Little substantive evidence exists that cleurly examines the cost-effectiveness of cardiac rehabilitation. This problem exists in virtually all aspects of medicine, and is related to the definition of cost-efectiveness and the interpretation of data regarding cost and effectiveness. This paper will discuss the dificulties in determining cost-effectiveness of cardiac rehabilitation services, and review the available data in this important area.