Home-based cardiac rehabilitation versus hospital-based rehabilitation: A cost effectiveness analysis

Background: Home-based cardiac rehabilitation offers an alternative to traditional, hospital-based cardiac rehabilitation. Aim: To compare the cost effectiveness of home-based cardiac rehabilitation and hospital-based cardiac rehabilitation. Methods: 104 patients with an uncomplicated acute myocardial infarction and without major comorbidity were randomized to receive home-based rehabilitation (n = 60) i.e. nurse facilitated, self-help package of 6 weeks' duration (the Heart Manual) or hospital-based rehabilitation for 8-10 weeks (n=44). Complete economic data were available in 80 patients (48 who received home-based rehabilitation and 32 who received hospital-based rehabilitation). Healthcare costs, patient costs, and quality of life (EQ-5D4.13) were assessed over the 9 months of the study. Results: The cost of running the home-based rehabilitation programme was slightly lower than that of the hospital-based programme (mean (95% confidence interval) difference -30 pound (-45 pound to -12) pound [-epsilon 44, -epsilon 67 to -epsilon 18] per patient. The cost difference was largely the result of reduced personnel costs. Over the 9 months of the study, no significant difference was seen between the two groups in overall healthcare costs (78 pound, -1102 pound to 1191 pound [-epsilon 115, -epsilon 1631 to -epsilon 1763] per patient) or quality adjusted life-years (-0.06 (-0.15 to 0.02)). The lack of significant difference between home-based rehabilitation and hospital-based rehabilitation did not alter when different costs and different methods of analysis were used. Conclusions: The health gain and total healthcare costs of the present hospital-based and home-based cardiac rehabilitation programmes for patients after myocardial infarction appear to be similar. These initial results require affirmation by further economic evaluations of cardiac rehabilitation in different settings. (c) 2006 Elsevier Ireland Ltd. All rights reserved.