The economics of cardiac rehabilitation and lifestyle modification: A review of literature

Abstract

Despite misgivings about this literature, we, nevertheless, cautiously conclude that the preponderance of evidence would support a finding that a traditional, exercise-based cardiac rehabilitation program is economically advantageous. When earlier return to work was factored in, a Swedish study by Levin et al2 found a highly favorable benefit/cost ratio of 51:1. It appears that cardiac rehabilitation not only saves on rehospitalization expense but also that the net cost per QALY is really quite moderate (if not zero). A cost-effectiveness analysis based on a meta-analysis by Ades et al4 found that savings in hospital charges offset about two thirds of the cost of cardiac rehabilitation ($3,671 in 2003 US dollars), giving a favorable cost per year of life saved of only $6,109 (in 2003 US dollars). Analysis of a Canadian trial by Oldridge et al6 found a cost per year of life saved of $11,749 in 2003 US dollars. In addition, the literature provides intriguing, albeit inconclusive, evidence that home-based cardiac rehabilitation alternatives are not only less costly but also similarly effective as hospital-based programs. This literature provides no evidence whatsoever on the economics (ie, benefits and costs) of specific dietary modifications or more intensive, multimodality approaches to cardiac lifestyle modification. Moreover, there have been no economic studies of more intensive and arguably more costly lifestyle modification programs, such as Dr Dean Ornish's well-known lifestyle modification program [Ornish D. Dr. Dean Ornish's Program for Reversing Heart Disease. New York: Ivy Books; 1996] and the Mind/Body Medical Institute's cardiac wellness program [Casey A, Benson H. Mind Your Heart: A Mind/Body Approach to Stress Management, Exercise and Nutrition for Health. New York: Simon and Schuster; 2004]. There is clearly a need for more economic research examining cardiac rehabilitation programs of all types. Copyright © Lippincott Williams & Wilkins.