Article type
Abstract
Background: The secondary prevention plays a fundamental role in patients after a cardiovascular event. One of the most effective interventions is Cardiac Rehabilitation (CR), but in Chile, this service is given only to 5% of candidate patients, mainly in urban areas and in the private health system, apparently due to its higher costs in comparison with usual care.
Objectives: To assess the cost-effectiveness of CR compared with usual care in survivors from an Acute Coronary Syndrome (ACS) from the perspective of the public health system in Chile.
Methods: A Markov Model was developed with 5 health states: ACS survivor, Second ACS, Complications, General Mortality, and CV Mortality. The transition probabilities between health states for usual care and corresponding relative risk (RR) for CR where obtained from a Cochrane systematic review. Health benefits were expressed as utilities and measured trough the EQ-5D-3L survey. Costs for each health state were identified and quantified from the national cost verification study and in some cases from focus surveys. The CR cost was estimated by a micro-costing system. Time horizon was lifetime and discount rate for both costs and outcomes was 3% per year. Deterministic and probabilistic analysis was performed with TreeAge Pro ©. Structural uncertainty was managed by designing of 3 scenarios: CR as actually is delivered in a specific public health centre (San José Model); CR as is recommended by South-American Guidelines (South-American Model), and CR as is proposed for low-resource settings (Low-Resource Model).
Results: Cost-effectiveness results of CR versus usual care showed an incremental cost-effectiveness ratio (ICER) for San José Model of $ 152,73 USD, for South-American Model of $ 358,70 USD, and for Low Resource Model of $ 128,92 USD. The estimated cost of CR for one entire programme for one patient was from $ 58,14 USD in the Low-Resource Model to $ 490,12 USD in the South-American Model.
Conclusions: Considering a cost effectiveness threshold of 1 GDP per capita (about $ 20.000 USD) the CR is highly cost effective for the public health system in Chile.
Objectives: To assess the cost-effectiveness of CR compared with usual care in survivors from an Acute Coronary Syndrome (ACS) from the perspective of the public health system in Chile.
Methods: A Markov Model was developed with 5 health states: ACS survivor, Second ACS, Complications, General Mortality, and CV Mortality. The transition probabilities between health states for usual care and corresponding relative risk (RR) for CR where obtained from a Cochrane systematic review. Health benefits were expressed as utilities and measured trough the EQ-5D-3L survey. Costs for each health state were identified and quantified from the national cost verification study and in some cases from focus surveys. The CR cost was estimated by a micro-costing system. Time horizon was lifetime and discount rate for both costs and outcomes was 3% per year. Deterministic and probabilistic analysis was performed with TreeAge Pro ©. Structural uncertainty was managed by designing of 3 scenarios: CR as actually is delivered in a specific public health centre (San José Model); CR as is recommended by South-American Guidelines (South-American Model), and CR as is proposed for low-resource settings (Low-Resource Model).
Results: Cost-effectiveness results of CR versus usual care showed an incremental cost-effectiveness ratio (ICER) for San José Model of $ 152,73 USD, for South-American Model of $ 358,70 USD, and for Low Resource Model of $ 128,92 USD. The estimated cost of CR for one entire programme for one patient was from $ 58,14 USD in the Low-Resource Model to $ 490,12 USD in the South-American Model.
Conclusions: Considering a cost effectiveness threshold of 1 GDP per capita (about $ 20.000 USD) the CR is highly cost effective for the public health system in Chile.