Cost-effectiveness of cardiac rehabilitation after myocardial infarction.
Cost-effectiveness of cardiac rehabilitation after myocardial infarction.
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DOI：
10.1097/00008483-199707000-00002
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发表时间：
1997-07-01
期刊：
影响因子：
--
通讯作者：
Nestor, J R
中科院分区：
文献类型：
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作者：
Ades, P A;Pashkow, F J;Nestor, J R
背景技术背景：心脏康复是心肌梗死（MI）后的常见处方，以协调运动训练和二级预防服务。成本效益分析允许定量比较心脏康复与其他常见干预措施的相对经济价值。方法：心脏康复的成本效益，以每年挽救生命的美元（$/YLS）为单位，通过结合心脏康复对死亡率的随机试验，总梗死后人群长期生存的流行病学研究，和康复服务的患者收费和避免康复后住院的医疗费用的研究。结果：心脏康复参与者在15年期间经历了0.202年的预期寿命增加。1988年，康复和运动测试的平均费用为1，485美元，部分被避免的心脏再住院费用抵消，每位患者850美元。1980年代后期确定的成本效益值为2，130美元/每年，预计1995年为4，950美元/每年。敏感性分析支持研究结果。结论：与其他心肌梗死后治疗干预相比，心脏康复比溶栓治疗，冠状动脉搭桥手术和降胆固醇药物更具成本效益，但不如戒烟计划的成本效益。心脏康复应与这些疗法一起作为MI后环境中的标准治疗。
BACKGROUND: Cardiac rehabilitation is commonly prescribed after myocardial infarction (MI) to coordinate exercise training and secondary preventive services. Cost-effectiveness analysis allows the quantitative comparison of the relative economic worth of cardiac rehabilitation in relation to other common interventions.METHODS: The cost-effectiveness of cardiac rehabilitation, in dollars per year of life saved ($/YLS), was calculated by combining published results of randomized trials of cardiac rehabilitation on mortality rates, epidemiologic studies of long-term survival in the overall postinfarction population, and studies of patient charges for rehabilitation services and averted medical expenses for hospitalizations after rehabilitation.RESULTS: Cardiac rehabilitation participants experienced an incremental life expectancy of 0.202 years during a 15-year period. In 1988, the average cost of rehabilitation and exercise testing was $1,485, partially offset by averted cardiac rehospitalizations of $850 per patient. A cost-effectiveness value of 2,130 $/YLS was determined for the late 1980s, projected to a value of 4,950 $/YLS for 1995. A sensitivity analysis supports the study results.CONCLUSIONS: Compared with other post-MI treatment interventions, cardiac rehabilitation is more cost-effective than thrombolytic therapy, coronary bypass surgery, and cholesterol lowering drugs, though less cost-effective than smoking cessation programs. Cardiac rehabilitation should stand alongside these therapies as standard of care in the post-MI setting.