Cost-effectiveness of exercise therapy in patients with coronary heart disease, chronic heart failure and associated risk factors: a systematic review of economic evaluations of randomized clinical trials

Oldridge, N. and Taylor, R. S. (2020) Cost-effectiveness of exercise therapy in patients with coronary heart disease, chronic heart failure and associated risk factors: a systematic review of economic evaluations of randomized clinical trials. European Journal of Preventive Cardiology, 27(10), pp. 1045-1055. (doi: 10.1177/2047487319881839) (PMID:31657233)

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Abstract

AIMS:Prescribed exercise is effective in adults with coronary heart disease (CHD), chronic heart failure (CHF), intermittent claudication, body mass index (BMI) ≥25 kg/m2, hypertension or type 2 diabetes mellitus (T2DM), but the evidence for its cost-effectiveness is limited, shows large variations and is partly contradictory. Using World Health Organization and American Heart Association/American College of Cardiology value for money thresholds, we report the cost-effectiveness of exercise therapy, exercise training and exercise-based cardiac rehabilitation. METHODS:Electronic databases were searched for incremental cost-effectiveness and incremental cost-utility ratios and/or the probability of cost-effectiveness of exercise prescribed as therapy in economic evaluations conducted alongside randomized controlled trials (RCTs) published between 1 July 2008 and 28 October 2018. RESULTS:Of 19 incremental cost-utility ratios reported in 15 RCTs in patients with CHD, CHF, intermittent claudication or BMI ≥25 kg/m2, 63% met both value for money thresholds as 'highly cost-effective' or 'high value', with 26% 'not cost-effective' or of 'low value'. The probability of intervention cost-effectiveness ranged from 23 to 100%, probably due to the different populations, interventions and comparators reported in the individual RCTs. Confirmation with the Consolidated Health Economic Evaluation Reporting checklist varied widely across the included studies. CONCLUSIONS:The findings of this review support the cost-effectiveness of exercise therapy in patients with CHD, CHF, BMI ≥25 kg/m2 or intermittent claudication, but, with concerns about reporting standards, need further confirmation. No eligible economic evaluation based on RCTs was identified in patients with hypertension or T2DM.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor, Professor Rod
Authors: Oldridge, N., and Taylor, R. S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:European Journal of Preventive Cardiology
Publisher:SAGE
ISSN:2047-4873
ISSN (Online):2047-4881
Published Online:26 October 2019

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