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.
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.
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.
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 (firstname.lastname@example.org).
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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