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Cardiac telerehabilitation is cost-effective for coronary artery disease

JAMA Network Open
Reuters Health - 06/01/2022 - Cardiac rehabilitation delivered via telemedicine may be more cost-effective for preventing relapse in coronary artery disease patients than traditional in-person delivery, a Dutch study suggests.

Researchers examined data on 300 patients with coronary artery disease who were randomly assigned to telemedicine or traditional in-person delivery of cardiac rehabilitation for relapse prevention. The study assessed quality of life at one year, as well as societal costs based on cardiac health care costs, noncardiac health care costs, and costs not directly related to medical care.

Mean intervention costs were significantly higher for cardiac rehabilitation delivered via telemedicine, at 224 euros ($252.81) compared with traditional in-person delivery at 156 euros ($176.06). Mean societal costs were lower with telemedicine at 20,495 euros ($23,130.66) than with traditional in-person delivery at 24,381 euros ($27,516.40), although this difference wasn't statistically significant, according to the results in JAMA Network Open.

"The CTR cardiac telerehabilitation intervention was found to be likely cost-effective as compared to center-based cardiac rehabilitation due to similar effects on quality of life and a nonsignificant cost difference in favor of cardiac rehabilitation," said lead study author Dr. Rutger Brouwers of the Vitality Center and Department of Cardiology at Maxima Medical Center, Eindhoven/Veldhoven, in the Netherlands.

Cost can be saved in both healthcare costs such as reduced outpatient visits due to the use of telehealth/telemonitoring and non-healthcare costs such as earlier work resumption and earlier resumption of other activities such as unpaid labor, Dr. Brouwers said by email.

Both intervention groups followed similar exercise training modules with individually adjusted resistance, aerobic, and functional training components. Aerobic training included two 60-minute sessions per week. Both groups also received outpatient psychological counseling in a clinic setting.

The telemedicine group participated in a web-based rehabilitation program and wore heart rate monitors and accelerometers. They received six supervised group sessions as well as weekly video consultations with the physical therapist. Traditional rehabilitation in person also involved group exercise sessions.

As part of the cost-benefit analysis, participants reported how often they attended or missed work as well as any medication usage, general healthcare visits, hospital visits and admissions, and home care.

Researchers also assessed quality-adjusted life years (QALY) using the EuroQol 5-Dimension 5 Level Survey. The total mean QALY for four quarters of the year combined was 0.841 with telerehabilitation and 0.044 with in-person rehabilitation, a difference that wasn't statistically significant. A separate assessment using the EuroQol Visual Analog Scale got similar results.

There are several limitations to the analysis, including the potential for recall bias in the healthcare consumption questionnaires completed to assess utilization and the single-center nature of the study.

Even so, the results suggest that telemedicine should be a viable option for coronary artery disease patients, Dr. Brouwers said.

"Our findings suggest that cardiac telerehabilitation can be offered to patients with coronary artery disease as an alternative to center-based cardiac rehabilitation," Dr. Brouwers said. "Ideally, patients should be able to choose together with their doctors which cardiac rehabilitation modality best suits their preferences."

SOURCE: https://bit.ly/34ivBI0 JAMA Network Open, online December 2, 2021. ($1 = 0.8861 euros)

By Lisa Rapaport

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