TY - JOUR
T1 - EU-CaRE study: Could exercise-based cardiac telerehabilitation also be cost-effective in elderly?
AU - Scherrenberg, M.
AU - Zeymer, U.
AU - Schneider, S.
AU - Velde, A.E.V.
AU - Wilhelm, M.
AU - Hof, A.W.J.V.
AU - Kolkman, E.
AU - Prins, L.F.
AU - Prescott, E.
AU - Iliou, M.C.
AU - Pena-Gill, C.
AU - Ardissino, D.
AU - De Kluiver, E.P.
AU - Dendale, P.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 634439. For the Swiss consortium partner, funding was received by the Swiss State Secretariat for Education, Research and Innovation under contract number 15.0139. TM, PE and MW report grants from State Secretariat for Education, Research and Innovation SERI, Swiss National Funding Agency. MCI, WB, LFP, EK, EPdK report grants from European Union.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background: The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease. Unfortunately, the participation rates across Europe remain low, especially in elderly. The EU-CaRE RCT investigated the effectiveness of a home-based mobile CR programme in elderly patients that were not willing to participate in centre-based CR. The initial study concluded that a 6-month home-based mobile CR programme was safe and beneficial in improving VO
2peak when compared with no CR. Objective: To assess whether a 6-month guided mobile CR programme is a cost-effective therapy for elderly patients who decline participation in CR. Methods: Patients were enrolled in a multicentre randomised clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. A total of 179 patients who declined participation in centre-based CR and met the inclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programs in the Elderly trial. The data of patients (n = 17) that were lost in follow-up were excluded from this analysis. The intervention (n = 79) consisted of 6 months of mobile CR programme with telemonitoring, and coaching based on motivational interviewing to stimulate patients to reach exercise goals. Control patients did not receive any form of CR throughout the study period. The costs considered for the cost-effectiveness analysis of the RCT are direct costs 1) of the mobile CR programme, and 2) of the care utilisation recorded during the observation time from randomisation to the end of the study. Costs and outcomes (utilities) were compared by calculation of the incremental cost-effectiveness ratio. Results: The healthcare utilisation costs (P = 0.802) were not significantly different between the two groups. However, the total costs were significantly higher in the intervention group (P = 0.040). The incremental cost-effectiveness ratio for the primary endpoint VO
2peak at 6 months was €1085 per 1-unit [ml/kg/min] improvement in change VO
2peak and at 12 months it was €1103 per 1 unit [ml/kg/min] improvement in change VO2peak. Big differences in the incremental cost-effectiveness ratios for the primary endpoint VO
2peak at 6 months and 12 months were present between the adherent participants and the non-adherent participants. Conclusion: From a health-economic point of view the home-based mobile CR programme is an effective and cost-effective alternative for elderly cardiac patients who are not willing to participate in a regular rehabilitation programme to improve cardiorespiratory fitness. The change of QoL between the mobile CR was similar for both groups. Adherence to the mobile CR programme plays a significant role in the cost-effectiveness of the intervention. Future research should focus on the determinants of adherence, on increasing the adherence of patients and the implementation of comprehensive home-based mobile CR programmes in standard care.
AB - Background: The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease. Unfortunately, the participation rates across Europe remain low, especially in elderly. The EU-CaRE RCT investigated the effectiveness of a home-based mobile CR programme in elderly patients that were not willing to participate in centre-based CR. The initial study concluded that a 6-month home-based mobile CR programme was safe and beneficial in improving VO
2peak when compared with no CR. Objective: To assess whether a 6-month guided mobile CR programme is a cost-effective therapy for elderly patients who decline participation in CR. Methods: Patients were enrolled in a multicentre randomised clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. A total of 179 patients who declined participation in centre-based CR and met the inclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programs in the Elderly trial. The data of patients (n = 17) that were lost in follow-up were excluded from this analysis. The intervention (n = 79) consisted of 6 months of mobile CR programme with telemonitoring, and coaching based on motivational interviewing to stimulate patients to reach exercise goals. Control patients did not receive any form of CR throughout the study period. The costs considered for the cost-effectiveness analysis of the RCT are direct costs 1) of the mobile CR programme, and 2) of the care utilisation recorded during the observation time from randomisation to the end of the study. Costs and outcomes (utilities) were compared by calculation of the incremental cost-effectiveness ratio. Results: The healthcare utilisation costs (P = 0.802) were not significantly different between the two groups. However, the total costs were significantly higher in the intervention group (P = 0.040). The incremental cost-effectiveness ratio for the primary endpoint VO
2peak at 6 months was €1085 per 1-unit [ml/kg/min] improvement in change VO
2peak and at 12 months it was €1103 per 1 unit [ml/kg/min] improvement in change VO2peak. Big differences in the incremental cost-effectiveness ratios for the primary endpoint VO
2peak at 6 months and 12 months were present between the adherent participants and the non-adherent participants. Conclusion: From a health-economic point of view the home-based mobile CR programme is an effective and cost-effective alternative for elderly cardiac patients who are not willing to participate in a regular rehabilitation programme to improve cardiorespiratory fitness. The change of QoL between the mobile CR was similar for both groups. Adherence to the mobile CR programme plays a significant role in the cost-effectiveness of the intervention. Future research should focus on the determinants of adherence, on increasing the adherence of patients and the implementation of comprehensive home-based mobile CR programmes in standard care.
KW - Digital health
KW - Mobile health
KW - Elderly
KW - Cardiac rehabilitation
KW - Secondary prevention
KW - Coronary artery disease
KW - Telerehabilitation
KW - REHABILITATION PROGRAMS
U2 - 10.1016/j.ijcard.2021.08.024
DO - 10.1016/j.ijcard.2021.08.024
M3 - Article
C2 - 34419529
SN - 0167-5273
VL - 340
SP - 1
EP - 6
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -