Cost-effectiveness of telerehabilitation in patients with heart failure in Poland: an analysis based on the results of Telerehabilitation in the Heart Failure Patients (TELEREH-HF) randomized clinical trial

Background: TELEREH-HF study showed a statistically significant improvement in the tertiary outcomes i.e. New York Heart Association (NYHA) class after a 9 week follow-up, consistent with telerehabilitation-related benefit in quality of life (QoL) measured by the 36-Item Short Form questionnaire (SF-36). Aim: We analyzed the cost-effectiveness of hybrid telerehabilitation compared to standard care in heart failure patients in the Polish setting using findings from the TELEREH-HF trial. Methods: Cost-utility analysis was conducted from a public payer (Polish National Health Fund) perspective. The quality-adjusted life year (QALY) measure was based on QoL, as survival benefit was not confirmed in the TELEREH-HF. Utility values were estimated based on NYHA improvement and a systematic review of NYHA-specific utility values. Alternatively, SF-36 results were translated into utility values. Telerehabilitation costs covered 8 weeks, 5 days/week, at a daily cost of 74 PLN. Standard care costs resulted from extra in-patient and out-patient rehabilitation costs incurred for selected patients. A lifetime horizon was adopted, with an estimated average survival time of 3.9 years based on 2 years TELEREH-HF follow up and subsequent literature-derived prognosis. Results: Base case analysis yielded a 0.044 and 0.027 gain in QALY for the NYHA- and SF-36-based approach, corresponding to a cost per QALY of 58.7 and 96 thousand PLN, respectively. Sensitivity analysis confirmed that the cost per QALY value was likely below the official cost-effectiveness threshold in Poland. Conclusions: The use of telerehabilitation was found cost-effective in Poland, i.e., the clinical benefits justify the additional costs.