Cost-effectiveness of home-based cardiac rehabilitation: a systematic review

Gemma E. Shields, Aleix Rowlandson, Garima Dalal, Stuart Nickerson, Holly Cranmer, Lora Capobianco, Patrick Doherty

Research output: Contribution to journalReview articlepeer-review

Abstract

Objective
Centre-based cardiac rehabilitation (CR) is recognised as cost-effective for individuals following a cardiac event. However, home-based alternatives are becoming increasingly popular, especially since COVID-19, which necessitated alternative modes of care delivery. This review aimed to assess whether home-based CR interventions are cost-effective (versus centre-based CR).

Methods
Using the MEDLINE, Embase and PsycINFO databases, literature searches were conducted in October 2021, to identify full economic evaluations (synthesising costs and effects). Studies were included if they focused on home-based elements of a CR programme, or full home-based programmes. Data extraction and critical appraisal were completed using the NHS EED handbook, CHEERS and Drummond checklists, and were summarised narratively. The protocol was registered on the PROSPERO database (CRD42021286252).

Results
Nine studies were included in the review. Interventions were heterogenous in terms of delivery, components of care and duration. Most studies were economic evaluations within clinical trials (8/9). All studies reported quality-adjusted life-years (QALYs), with the EQ-5D as the most common measure of health status (6/9 studies). Most studies (7/9 studies) concluded that home-based CR (added to or replacing centre-based CR) was cost-effective compared to centre-based options.

Conclusions
Evidence suggests home-based CR options are cost-effective. The limited size of the evidence base and heterogeneity in methods limits external validity. There were further limitations to the evidence base (e.g., limited sample sizes) that increase uncertainty. Future research is needed to cover a greater range of home-based designs, including home-based options for psychological care, with greater sample sizes and the potential to acknowledge patient heterogeneity.
Original languageEnglish
JournalHeart
Publication statusAccepted/In press - 8 Feb 2023

Keywords

  • cardiac rehabilitation
  • economic evaluation
  • systematic review
  • cost-effectiveness

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