Short-Term Cost–Utility Analysis of Once-Weekly Supervised Outpatient Cardiac Rehabilitation ― A Single-Center Retrospective Cohort Study Using a Hypothetical Nonparticipation Scenario ―

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular disease (ischemic heart disease or heart failure) (n=41). Intervention: Once-weekly supervised outpatient cardiac rehabilitation vs. Hypothetical nonparticipation scenario (simulated comparator assuming unchanged baseline utility). Primary outcome: Incremental quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) over 150 days (MD 0.0205 QALYs (ICER JPY 6,311,398/QALY), 95% CI 0.0122-0.0297).

Satoshi Suzuki; Tomohito Suzuki

doi:10.1253/circrep.cr-26-0265

October 22, 2026Circulation ReportsOpen Access

Short-Term Cost–Utility Analysis of Once-Weekly Supervised Outpatient Cardiac Rehabilitation ― A Single-Center Retrospective Cohort Study Using a Hypothetical Nonparticipation Scenario ―

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Key result

Weekly outpatient cardiac rehabilitation improves quality of life, yielding ~0.02 incremental QALYs over 150 days.

MD +0.0205 QALYs (ICER JPY 6,311,398/QALY)
95% CI 0.0122-0.0297
n=41

Why the study?

Resource-limited institutions may only be able to deliver outpatient cardiac rehabilitation at a low frequency, and the economic value of once-weekly supervised outpatient cardiac rehabilitation remained uncertain.

Does once-weekly supervised outpatient cardiac rehabilitation provide short-term cost-effective quality-of-life gains compared with a hypothetical nonparticipation scenario in patients with ischemic heart disease or heart failure?

Key Points

To evaluate the short-term cost–utility of a 150-day once-weekly supervised outpatient cardiac rehabilitation program compared with a hypothetical nonparticipation scenario in a resource-limited setting.
Single-center retrospective cohort study evaluating 41 patients with cardiovascular disease (68.3% ischemic heart disease, 31.7% heart failure; mean age 76.9 years) who completed a 150-day once-weekly outpatient cardiac rehabilitation program.
Evaluated health-related quality of life with EQ-5D-5L utility scores and modeled incremental QALYs and costs against a hypothetical nonparticipation comparator whose utility was assumed to stay constant from baseline.
Mean EQ-5D-5L utility increased from 0.816±0.184 at baseline to 0.916±0.101 at 150 days (mean change: 0.100, 95% CI: 0.055–0.144), with utility improving in 61.0% of patients and reaching 1.000 in 51.2%.
In the base-case analysis, incremental QALY was 0.0205 (95% CI: 0.0122–0.0297) and incremental cost was JPY 129,149, yielding an ICER of JPY 6.31 million/QALY, which exceeded the willingness-to-pay threshold of JPY 5 million/QALY (11.6% probability of cost-effectiveness).
One-way sensitivity analyses showed the ICER fell below the willingness-to-pay threshold if the utility gain was achieved within 90 days or if the gain persisted for ≥30 days beyond day 150.

Study Design

Type

Cohort (n=41)

Multicenter

No

Structured PICO

Does once-weekly supervised outpatient cardiac rehabilitation provide short-term cost-effective quality-of-life gains compared with a hypothetical nonparticipation scenario in patients with ischemic heart disease or heart failure?

P

Population

41 older adults in Japan with ischemic heart disease (68.3%) or heart failure (31.7%), mean age 76.9 years and 29.3% female, who completed a 150-day once-weekly supervised outpatient cardiac rehabilitation program.

E

Exposure

Once-weekly supervised outpatient cardiac rehabilitation program delivered over 150 days, consisting of 3 rehabilitation units (20 minutes per unit, reimbursed at 205 points per unit) once weekly (21 sessions per patient), including vital-sign assessment, risk management, warm-up exercises, resistance training, aerobic exercise, and individualized lifestyle counseling and disease-specific education.

C

Comparator

Hypothetical nonparticipation scenario (simulated comparator) representing the same patients had they not participated in cardiac rehabilitation, assuming baseline EQ-5D-5L utility remained constant over 150 days and subtracting Cardiac and Major Vascular Rehabilitation (Category I) fees from direct outpatient medical costs while retaining consultation and examination costs.

O

Outcome

Short-term cost-utility over 150 days measured by EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility change, incremental quality-adjusted life-years (QALYs) calculated via the trapezoidal method, incremental direct outpatient medical costs in Japanese yen (JPY), and the incremental cost-effectiveness ratio (ICER) evaluated against a willingness-to-pay threshold of JPY 5 million/QALY.patient reported

Main Result

Mean Difference: 0.0205 (95% CI 0.0122–0.0297)

Absolute Event Rate: 0.916% vs 0.816%

Once-weekly supervised outpatient cardiac rehabilitation improved quality of life over 150 days, but its short-term base-case ICER (JPY 6.31 million/QALY) exceeded Japan's willingness-to-pay threshold unless utility gains occurred within 90 days or persisted for at least 30 days post-program.

Limitations

QOL trajectory in the simulated comparator, timing of the utility gain in the CR group, and duration of benefit beyond day 150 were based on assumptions because QOL was assessed only at baseline and day 150.
Small, single-center retrospective observational study with no actual control group, limiting generalizability and precluding separation of CR effects from confounding factors, other treatments, or spontaneous recovery.
Exclusion of 6 patients with missing QOL data and 2 patients who discontinued the program introduces potential selection bias.
Study population combined patients with ischemic heart disease and heart failure, which have distinct clinical trajectories.
The QOL trajectory in the simulated comparator, timing of the utility gain in the CR group, and duration of benefit beyond day 150 were based on assumptions because QOL was only assessed at baseline and day 150.
Small, single-center retrospective observational study design limits generalizability and cannot eliminate confounding factors.
Lack of an actual control group meant the effects of treatments other than CR and spontaneous recovery could not be separated.
Potential selection bias due to the exclusion of 6 patients with missing QOL data and 2 patients who discontinued the program.
The study population combined patients with ischemic heart disease and heart failure, which have distinct clinical backgrounds.

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Implication

Once-weekly cardiac rehabilitation improved utility yet exceeded ICER threshold in this cohort; hypothesis-generating and requires randomized confirmation before practice consideration.

Abstract

Background: Resource-limited institutions may only be able to deliver outpatient cardiac rehabilitation (CR) at a low frequency, but its economic value remains uncertain, so in this exploratory study we evaluated the short-term cost–utility of once-weekly supervised outpatient CR using a hypothetical nonparticipation comparator. Methods and Results: This single-center retrospective study included 41 patients who completed a 150-day once-weekly outpatient CR program and had completed EQ-5D-5L and cost data. Utility was assumed to remain unchanged in the hypothetical nonparticipation group and to improve linearly over 150 days in the CR group. Mean EQ-5D-5L utility increased from 0.816 to 0.916. In the base-case analysis, the incremental QALY was 0.0205 (95% confidence interval, 0.0122–0.0297), the incremental cost was JPY 129,149, and the incremental cost-effectiveness ratio (ICER) was JPY 6.31 million/QALY, exceeding the willingness-to-pay threshold of JPY 5 million/QALY. The probability of cost-effectiveness was 11.6%. The ICER fell below the threshold when the utility gain was assumed to occur within 90 days or persist for ≥30 days beyond day 150. Conclusions: Once-weekly supervised outpatient CR was associated with improved QOL, but the base-case ICER exceeded the willingness-to-pay threshold. Cost-effectiveness was highly sensitive to the assumed timing and persistence of the utility gain.

Discussion

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Cite This Study

Suzuki et al. (2026) conducted a cohort in Cardiovascular disease (ischemic heart disease or heart failure) (n=41). Once-weekly supervised outpatient cardiac rehabilitation vs. Hypothetical nonparticipation scenario (simulated comparator assuming unchanged baseline utility) was evaluated on Incremental quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) over 150 days (MD 0.0205 QALYs (ICER JPY 6,311,398/QALY), 95% CI 0.0122-0.0297). Once-weekly supervised outpatient cardiac rehabilitation improved EQ-5D-5L utility from 0.816 to 0.916, yielding 0.0205 incremental QALYs and an ICER of JPY 6.31 million/QALY.

synapsesocial.com/papers/6adb45affa57c0e8502b9471 https://doi.org/10.1253/circrep.cr-26-0265

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Short-Term Cost–Utility Analysis of Once-Weekly Supervised Outpatient Cardiac Rehabilitation ― A Single-Center Retrospective Cohort Study Using a Hypothetical Nonparticipation Scenario ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Short-Term Cost–Utility Analysis of Once-Weekly Supervised Outpatient Cardiac Rehabilitation ― A Single-Center Retrospective Cohort Study Using a Hypothetical Nonparticipation Scenario ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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