Advertisement

Cost-effectiveness analysis of long-term moderate exercise training in chronic heart failure

      Abstract

      The purpose of this study is to perform a cost-effectiveness analysis of long-term moderate exercise training (ET) in patients with stable chronic heart failure. In particular, the study focuses on the survival analysis and cost savings from the reduction in the hospitalization rate in the exercise group. In the past 10 years, ET has been shown to be beneficial for patients with stable class II and III heart failure in many randomized clinical trials. However, the cost-effectiveness of a long-term ET program has not been addressed for outcomes related to morbidity/mortality end points or health care utilization. We examined the cost-effectiveness of a 14-month long-term training in patients with stable chronic heart failure. The estimated increment cost for the training group, $3,227/patient, was calculated by subtracting the averted hospitalization cost, $1,336/patient, from the cost of ET and wage lost due to ET, estimated at $4,563/patient. For patients receiving ET, the estimated increment in life expectancy was 1.82 years/person in a time period of 15.5 years, compared with patients in the control group. The cost-effectiveness ratio for long-term ET in patients with stable heart failure was thus determined at $1,773/life-year saved, at a 3% discount rate. Long-term ET in patients with stable chronic heart failure is cost-effective and prolongs survival by an additional 1.82 years at a low cost of $1,773 per/life-year saved.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Belardinelli R
        • Georgiou D
        • Cianci G
        • Purcaro A
        Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life, and clinical outcome.
        Circulation. 1999; 99: 1173-1182
        • Sullivan M.J
        • Higginbotham M.B
        • Cobb F.R
        Exercise training in patients with chronic heart failure delays ventilatory anaerobic threshold and improves submaximal exercise performance.
        Circulation. 1989; 79: 324-329
        • Sullivan M.J
        • Higginbotham M.B
        • Cobb F.R
        Exercise training in patients with severe left ventricular dysfunction.
        Circulation. 1988; 78: 506-515
        • Coats A.J.S
        • Adamopoulos S
        • Meyer T.E
        • Conway J
        • Sleight P
        Effects of physical training in chronic heart failure.
        Lancet. 1990; 335: 63-66
        • Coats A.J.S
        • Adamopoulos S
        • Radaelli A
        • McCance A
        • Meyer T.E
        • Bernardi L
        • Solda P.L
        • Davey P
        • Ormerod O
        • Forfar C
        • Conway J
        • Sleight P
        Controlled trial of physical training in chronic heart failure.
        Circulation. 1992; 85: 2119-2131
        • Belardinelli R
        • Georgiou D
        • Scocco V
        • Barstow T.J
        • Purcaro A
        Low intensity exercise training in patients with chronic heart failure.
        J Am Coll Cardiol. 1995; 26: 975-982
        • Horning B
        • Maier V
        • Drexler H
        Physical training improves endothelial function in patients with chronic hear failure.
        Circulation. 1996; 93: 210-214
        • Hambrecht R
        • Fiehn E
        • Weigl C
        • Gielen S
        • Hamann C
        • Kaiser R
        • Yu J
        • Adams V
        • Niebauer J
        • Schuler G
        Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure.
        Circulation. 1998; 98: 2709-2715
        • Minotti J.R
        • Johnson E.C
        • Hudson T.H
        • Zuroske G
        • Murata G
        • Fukushima E
        • Cagle T.G
        • Chick T.W
        • Massie B.M
        • Lcenogle M.V
        Skeletal muscle response to exercise training in congestive heart failure.
        J Clin Invest. 1990; 86: 751-758
        • Adamopoulos S
        • Coats A.J.S
        • Brunotte F
        • Arnolda L
        • Meyer T
        • Thompson C.H
        • Dunn J.F
        • Stratton J
        • Kemp G.J
        • Radda G.K
        • Rajagopalan B
        Physical training improves skeletal muscle metabolism in patients with chronic heart failure.
        J Am Coll Cardiol. 1993; 21: 1101-1106
        • Drummond M
        • O’Brien B
        • Stoddart G
        • Torrance G
        Methods for the Economic Evaluation of Health Care Programs. 2nd ed. Oxford University Press, New York1997
        • Bigger Jr, J.T
        • Parides M.K
        • Rolnitsky L.M
        • Meier P
        • Levin B
        • Egan D.A
        Changes in sample size and length of follow-up to maintain power in The Coronary Artery Bypass Graft (CABG) patch trial.
        Controlled Clin Trials. 1998; 19: 1-14
        • Cornoni-Huntley J
        • Barbano H.E
        • Brody J.A
        National health, and nutrition examination I—epidemiologic follow-up survey.
        Public Health Rep. 1983; 96: 245-251
        • Schocken D
        • Arrieta M
        • Leaverton P
        Prevalence, and mortality rate of congestive heart failure in the United States.
        J Am Coll Cardiol. 1992; 20: 301-306
        • Pfeffer M.A
        • Braunwald E
        • Moye L.A
        • Basta L
        • Brown Jr, E.J
        • Cuddy T.E
        • Davis B.R
        • Geltman E.M
        • Goldman S
        • Flaker G.C
        • Klein M
        • Lamas G.A
        • Packer M
        • Rouleau J
        • Rouleau J.L
        • Rutherford J
        • Wertheimer J.H
        • Hawkins C.M
        • SAVE Investigators
        Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction.
        N Engl J Med. 1992; 327: 669-677
        • Garg R
        • Yusuf S
        Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality, and morbidity in patients with heart failure.
        JAMA. 1995; 273: 1450-1456
        • Delea T
        • Vera-Llonch M
        • Richner R
        • Fowler M
        • Oster G
        Cost-effectiveness of carvedilol for heart failure.
        Am J Cardiol. 1999; 83: 890-896
        • Weinstein M.C
        • Siegel J.E
        • Gold M.R
        • Kamlet M.S
        • Russell L.B
        Recommendations of the panel on cost-effectiveness in health and medicine.
        JAMA. 1996; 276: 1253-1258
        • Kupersmith J
        • Holmes-Rovner M
        • Hogan A
        • Rovner D
        • Gardiner J
        Cost-effectiveness analysis in heart diseases.
        Prog Cardiovasc Dis. 1995; 37: 243-271
        • Ades P
        • Pashkow F
        • Nestor J
        Cost-effectiveness of cardiac rehabilitation after myocardial infarction.
        J Cardiopulm Rehabil. 1997; 17: 222-231
        • Ades P
        • Huang D
        • Weaver S
        Cardiac rehabilitation participation predicts lower rehospitalization costs.
        Am Heart J. 1992; 123: 916-921
        • Petrie M
        • Dawson N
        • Murdoch D
        • Davie A
        • McMurray J
        Failure of women’s hearts.
        Circulation. 1999; 99: 2334-2341
        • Chin M
        • Goldman L
        Gender differences in 1-year survival, and quality of life among patients admitted with CHF.
        Med Care. 1998; 36: 1033-1046
        • Kimmelstiel C
        • Goldberg R
        Congestive heart failure in women. focus on heart failure due to coronary artery disease and diabetes.
        Cardiology. 1990; 77: 71-79
        • Rector T.S
        • Cohn J.N
        Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire.
        Am Heart J. 1992; 124: 1017-1024
        • Staquet M.J
        • Hays R.D
        • Fayers P.M
        Quality of Life Assessment in Clinical Trials. Oxford University Press, New York1998