Objectives
Cardiac rehabilitation (CR) is recognised as a cost-effective intervention which can be offered to people following a cardiac event. Home-based alternatives are being increasingly used (versus centre-based options), particularly since the COVID-19 pandemic. This study aimed to assess whether home-based interventions in the CR pathway have been demonstrated to be cost-effective, compared to conventional centre-based delivery, in a population undergoing CR.
Methods
Electronic searches of the PsycINFO, MEDLINE and Embase databases (via Ovid) were conducted to identify relevant published full economic evaluations. Studies were included if they reported a full economic evaluation of home-based CR programmes or an intervention that may be classed as an individual aspect of a comprehensive home-based CR programme, compared to centre-based CR options. The review was restricted to English language studies published within the last 15 years. The protocol was registered on the PROSPERO database (CRD42018108226).
Results
Database searches identified 2,572 initial records (1,865 after the removal of duplicates). Following screening of titles/abstracts, 53 full-text articles were assessed. Nine studies were included in the review. Interventions were heterogeneous in terms of delivery, components of care (e.g. exercise and behaviour change) and duration. All studies were economic evaluations alongside clinical trials, with sample sizes ranging from 53 to 778. All studies reported quality-adjusted life-years (QALYs), with the EQ-5D as the most common measure of health status (6/9 studies). Most studies (7/9 studies) concluded that home-based CR was cost-effective compared to centre-based options.
Conclusions
Evidence suggests that home-based CR is cost-effective, which is particularly pertinent given the need for non-centre-based options following the COVID-19 pandemic. There were some limitations to the evidence base, including sample size and limited time horizons. Given heterogeneity in intervention design and delivery, future research is needed to investigate patient preferences for CR intervention and the cost-effectiveness of different modes of delivery.