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Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome

Serón, Pamela, PhD; Gaete, Mónica, MSc; Oliveros, María-Jose; Román, Claudia, MSc; Lanas, Fernando, PhD; Velásquez, Monica, MSc; Reveco, Roberto, PhD; Bustos, Luis; Rojas, Rubén, MSc

Journal of Cardiopulmonary Rehabilitation and Prevention: May 2019 - Volume 39 - Issue 3 - p 168–174
doi: 10.1097/HCR.0000000000000356
Cardiac Rehabilitation
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Purpose: To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile.

Methods: A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings.

Results: Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state.

Conclusion: Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.

To assess the cost-effectiveness of exercise-based cardiac rehabilitation, a Markov model was developed using 5 health states and 3 models. The incremental cost-effectiveness ratios were as follows: $722 for the standard model, $1247 for the South American model, and $666 for the low-resource model, making cardiac rehabilitation a highly cost-effective alternative for the Chilean public health system.

Departamento de Medicina Interna—Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile (Drs Seron and Lanas and Ms Velásquez); Departamento de Medicina Interna, Universidad de La Frontera, Temuco, Chile (Mss Gaete and Oliveros); Complejo Hospitalario San José, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile (Ms Román); Facultad de Ciencias Jurídicas y Empresariales, Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile (Dr Reveco); Departamento de Salud Pública, Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile (Mr Bustos); and Unidad de Evaluación de Tecnologías Sanitarias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile (Mr Rojas).

Correspondence: Pamela Seron, PhD, Departamento de Medicina Interna, Centro de Excelencia CIGES, Universidad de La Frontera, Claro Solar 115, Of 304, Temuco, Chile (pamela.seron@ufrontera.cl).

This study was funded by Fondo Nacional de Investigación y Desarrollo en Salud FONIS—Chile (grant SA14ID0005).

The authors declare no conflicts of interest.

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