. 2020 Nov 23;1(1):20–29. doi: 10.1093/ehjdh/ztaa005

Table 2.

Characteristics of included studies

Author (year), country	Study design and sample population	Intervention	Comparator	Costs included	Economic outcome	Conclusion
Cowie and Moseley²³ (2013), UK	Three group RCT HF patients Mean age 64.3 years M 91.3% 5-year follow-up 46 patients	Eight-week home-training with a DVD and monitored by a senior CR physiotherapist by telephone (n = 15)	Eight-week hospital-training delivered as a 1 h, interval training, aerobic circuit class, twice per week (n = 15) Control group: usual care (n = 16)	Patients included in analysis (n = 46) Intervention (n = 15), hospital (n = 15), control (n = 16) Labour cost Equipment cost 5-year admission cost	Total cost-avoidance (£) Usual care: 7206.33£ Hospital-training: 38 325.33£ Home-training: 45 531.65£	Home-based and centre-based training incurred similar costs. Both had lower emergency admission compared to control.
Whittaker and Wade¹⁹ (2014), Australia	Two-arm RCT CAD patients Mean age 56 years M 83% 120 patients	Six-week home-based CR. Participants in the telehealth group received a mobile phone, Wellness Diary, and a Wellness web portal, with daily text messaging (n = 60)	Six-week hospital-based outpatient CR programme, including gym sessions. Both groups received comprehensive rehabilitative care encompassing exercise, risk modification and mentoring (n = 60)	Education Assessment Coaching and mentoring Gymnasiums Communications Facility Technology Administration Patient travel	Total health care cost (AU $) Intervention: $1713 Comparator: $2245 Between-group difference: $532 $2375 per patient savings in healthcare costs	Cost of delivery by telehealth was slightly lower than centre-based CR.
Frederix et al.18 (2015), Belgium	Single-centre, two-arm RCT CAD patients Mean age 61 years M 82% 1-year follow-up 139 patients	Six weeks in-centre CR. Thereafter 6 weeks in-centre CR + TeleCR and finally 18 weeks of TELE-CR alone. Patient-specific exercise training prescriptions and self-monitoring of activity by an accelerometer. Uploading of their data on web page with a semi-automatic telecoaching system that provided weekly feedback via email and/ or SMS. Also received weekly dietary and smoking cessation advice by email and/or SMS (n = 69)	Twelve weeks of in-centre CR (n = 70)	Patients included in analysis (n = 139) Intervention (n = 69), control (n = 70) Intervention cost 12-month use of healthcare Readmission Specialist visit Diagnostics	Total health care cost (€) Intervention: €2156 Comparator: €2720 Between-group difference: €-564 ICER: €-21707 per QALY	Addition of cardiac telerehabilitation to centre-based CR is more cost-effective than centre-based CR alone both after 1 year and 2-year follow-up.
Kidholm et al.21 (2016), Denmark	Multi-centre, two-arm RCT HF, CAD, cardiac surgery patients Mean age 62 years M 80% 1-year follow-up 141 patients	Three-month telerehabilitation programme with one home-visit. Technology used: tablet computer, digital BP device, weight scale, ECG, Fitbit ultra, and follow-up software (n = 72)	The control group followed a traditional rehabilitation programme at the hospital or healthcare centre based on CR guidelines (n = 69)	Patients included in analysis (n = 134) Intervention (n = 68), control (n = 66) Equipment Labour cost Cost of rehabilitation service 12-month use of healthcare GP Hospital Readmission	Total health care cost (€) Intervention: €5709 Comparator: €4045 Between-group difference: €1664 ICER: €518 280 per QALY	Mean total cost per patient was €1700 higher in intervention group. QALY gain was higher in intervention group (not statistically significant). CU ratio was >€400 000 per QALY gained.
Frederix et al.¹⁴ (2017), Belgium	Multi-centre, two-arm RCT CAD patients 2-year follow-up 134 patients -Long-term follow-up study of Frederix et al.²⁰	Six weeks in-centre CR + 6 weeks in-centre CR + TeleCR. Patient-specific exercise training prescriptions and self-monitoring of activity by an accelerometer. Uploading of their data on web page with a semi-automatic telecoaching system that provided weekly feedback via email and/ or SMS. Also received weekly dietary and smoking cessation advice by email and/or SMS (n = 62)	Twelve weeks of in-centre CR (n = 64)	Patients included in analysis (n = 134) Intervention (n = 68), control (n = 66) Intervention cost 2-year use of healthcare Readmission Specialist visit Diagnostics	Total health care cost (€) Intervention: €3262 Comparator: €4140 Between-group difference: €878 ICER: €3993 per QALY	See Frederix et al. 2015.
Kraal et al.²² (2017), The Netherlands	Single-centre, two-arm RCT CAD patients Mean age 59 years M 89% 1-year follow-up 90 patients	Twelve-week programme. First three supervised training sessions in the outpatient clinic. Heart rate monitor was used to record the exercise data. A web application was used by the patient, the physical therapist and the exercise specialist to review the data. Once a week the patient received feedback on training frequency, duration and intensity via telephone by the physical therapist. All other CR components were delivered in the outpatient clinic (n = 45)	Twelve-week training in the outpatient clinic, supervised by two physical therapists specialized in CR. All patients received an individually tailored training programme on a cycle ergometer and treadmill n = 45)	Patients included in analysis (n = 78) Intervention (n = 37), control (n = 41) 1-year healthcare cost GP Specialist Dietician Physiotherapist Readmission Medication CR service cost Intervention cost 1-year non-healthcare cost Absenteeism	Total health care cost (€) Intervention: €6265 Comparator: €9425 Between-group difference: €3160 No significant change QoL	No differences between telemonitoring and home-based training on physical fitness, physical activity level, or HRQOL. Home-based showed higher patient satisfaction and (not statistically significant) more cost-effectiveness after 1-year follow-up.
Hwang et al.²⁰ (2019), Australia	Multi-centre, two-arm RCT HF patients Mean age 67 years M 75% 6-month follow-up 53 patients	Twelve-week exercise and education intervention delivered into the patient’s home twice-weekly by a physiotherapist Technologies used: online videoconferencing, PowerPoint, laptop, finger oximetre, automatic BP device, mobile broadband device with 3G (n = 24)	Twelve-week centre-based CR programme based on current recommended guidelines encompassing education, aerobic, and strength training exercise (n = 29)	Patients included in analysis (n = 49) Intervention (n = 23), control (n = 26) Equipment Labour cost Travel cost 6-month readmission cost	Total health care cost (AU $) Intervention: $2325.09 Comparator: $3915.55 Between-group difference: $1590.45 ICER: -$4157 per QALY	Telerehabilitation for HF patients appeared to be less costly and as effective as centre-based CR.
Maddison et al.¹⁵ (2019), New Zealand	Two-arm RCT CAD patients Mean age 61 years M 86% 2-year follow-up 162 patients	Twelve weeks of individualized exercise prescription, exercise monitoring, and coaching via a bespoke telerehabilitation platform that comprised a smartphone and chest-worn wearable sensor (bespoke smartphone and web apps and custom middleware form (n = 82)	Twelve weeks of supervised exercise delivered by clinical exercise physiologists in CR clinics (n = 80)	Patients included in analysis (n = 134) Intervention (n = 65), control (n = 69) Intervention cost 2-year use of healthcare Hospital service Medications	Total health care cost (NZ$) Intervention: NZ$ 4920 Comparator: NZ$ 9535 Between-group difference: NZ$ 4615 No significant change QoL	REMOTE-CR is an effective and cost-efficient alternative model after a 2-year follow-up. Could improve overall utilization by increasing reach and satisfying participant preferences.

CAD, coronary artery disease; CR, cardiac rehabilitation; DVD, Digital Versatile Disc; GP, general practitioner; HF, heart failure; HRQOL, health-related quality of life; ICER, incremental cost-effectiveness ration; M, male; RCT, randomized controlled trial; SMS, short-message-service; UK, United Kingdom.