Cost-Effectiveness of Pain Management Strategies in Advanced Cancer

Objective To summarise the evidence on the cost-effectiveness of acupuncture. Methods We identified full economic evaluations such as cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) alongside randomised controlled trials (RCTs) that assessed the consequences and costs of acupuncture for any medical condition. Eleven electronic databases were searched up to March 2011 without language restrictions. Eligible RCTs were assessed using the Cochrane criteria for risk of bias and a modified version of the checklist for economic evaluation. The general characteristics and the results of each economic analysis such as incremental cost-effectiveness ratios (ICERs) were extracted. Results Of 17 included studies, nine were CUAs that measured quality-adjusted life years (QALYs) and eight were CEAs that assessed effectiveness of acupuncture based on improvements in clinical symptoms. All CUAs showed that acupuncture with or without usual care was cost-effective compared with waiting list control or usual care alone, with ICERs ranging from ¢3011/QALY (dysmenorrhoea) to ¢22 298/QALY (allergic rhinitis) in German studies, and from £3855/QALY (osteoarthritis) to £9951/QALY (headache) in UK studies. In the CEAs, acupuncture was beneficial at a relatively low cost in six European and Asian studies. All CUAs were well-designed with a low risk of bias, but this was not the case for CEAs. Conclusions Overall, this review demonstrates the cost-effectiveness of acupuncture. Despite such promising results, any generalisation of these results needs to be made with caution given the diversity of diseases and the different status of acupuncture in the various countries.

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‘It’s about willpower in the end. You’ve got to keep going’: a qualitative study exploring the experience of pain in inflammatory bowel disease

British Journal of Pain ◽

10.1177/2049463719844539 ◽

2019 ◽

Vol 13 (4) ◽

pp. 201-213 ◽

Cited By ~ 1

Author(s):

Louise Sweeney ◽

Rona Moss-Morris ◽

Wladyslawa Czuber-Dochan ◽

Laure Belotti ◽

Zoe Kabeli ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Pain Management ◽

Qualitative Study ◽

Bowel Disease ◽

Management Strategies ◽

Emotional Impact ◽

Management Interventions ◽

Inflammatory Bowel ◽

Behavioural Therapies ◽

Physical Impact

Background: Pain is a widely experienced symptom of inflammatory bowel disease (IBD), which has significant psychological and functional impacts on patients. Understanding the aetiology and management of chronic pain is a poorly understood area of IBD research. This qualitative study aimed to explore the experiences of individuals with IBD and pain, the pain management strategies they use and any needs for future pain management interventions. Methods: In all, 14 individuals with IBD were purposively recruited and interviewed (face-to-face or telephone) using a topic guide. Interviews were transcribed and analysed using inductive thematic analysis. Results: Themes identified were ‘vicious cycles’, ‘findings solutions’ and ‘attitudes’. The experience and impact of pain were rarely viewed in isolation, but rather within the context of a cycle of IBD symptoms. Other ‘vicious cycles’ identified included anxiety, avoidance and inactivity, and poor understanding and communication. Pain management included short- and long-term strategies. Searching for a solution for pain had an emotional impact on individuals. There were contrasting attitudes from participants, including defeat, tolerance and acceptance. Conclusion: This study provides an understanding of the experience of pain in IBD. The interaction of pain with accompanying IBD symptoms has an emotional and physical impact on individuals, and creates a barrier to adequate assessment, understanding and treatment of pain. Patients rely on their own experiences, and a trial and error approach to apply helpful strategies. Adjuvant behavioural therapies may be beneficial for patients experiencing pain and psychological distress, and to facilitate self-management.

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Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Programme Grants for Applied Research ◽

10.3310/pgfar05140 ◽

2017 ◽

Vol 5 (14) ◽

pp. 1-834 ◽

Cited By ~ 2

Author(s):

Denise Kendrick ◽

Joanne Ablewhite ◽

Felix Achana ◽

Penny Benford ◽

Rose Clacy ◽

...

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Injury Prevention ◽

Fire Safety ◽

Evidence Base ◽

Home Safety ◽

Case Control Studies ◽

Safety Interventions ◽

Meta Analyses ◽

Children’S Centres

BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.

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Cost-Effectiveness of Pain Management Services for Chronic Low Back Pain: A Systematic Review of Published Studies

10.21203/rs.2.11699/v3 ◽

2020 ◽

Author(s):

Saja Almazrou ◽

Rachel A Elliott ◽

Roger D Knaggs ◽

Shiekha S AlAujan

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Cost Effectiveness ◽

Pain Management ◽

Cost Effective ◽

Economic Evaluations ◽

Low Back ◽

Management Services

Abstract Background: Chronic low back pain (CLBP) is a highly prevalent condition that has substantial impact on patients, the healthcare system and society. Pain management services (PMS), which aim to address the complex nature of back pain, are recommended in clinical practice guidelines to manage CLBP. Although the effectiveness of such services has been widely investigated in relation to CLBP, the quality of evidence underpinning the use of these services remains moderate. Therefore the aim is to summarize and critically appraise the current evidence for the cost effectiveness of pain management services for managing chronic back pain. Methods: Electronic searches were conducted in MEDLINE, EMBASE and PsycINFO from their inception to February 2019. Full economic evaluations undertaken from any perspective conducted alongside randomized clinical trials (RCTs) or based on decision analysis models were included. Cochrane Back Review Group (CBRG) risk assessment and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist were used to assess the methodological quality of eligible studies. Results: Five studies fulfilled eligibility criteria. The interventions varied significantly between studies in terms of the number and types of treatment modalities, intensity and the duration of the program. Interventions were compared with either standard care, which varied according to the country and the setting; or to surgical interventions. Three studies showed that pain management services are cost effective, while two studies showed that these services are not cost effective. In this review, three out of five studies had a high risk of bias based on the design of the randomised controlled trials (RCTs). In addition, there were limitations in the statistical and sensitivity analyses in the economic evaluations. Therefore, the results from these studies need to be interpreted with caution. Conclusion Pain management services may be cost effective for the management of low back pain. However, this systematic review highlights the variability of evidence supporting pain management services for patients with back pain. This is due to the quality of the published studies and the variability of the setting, interventions, comparators and outcomes.

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Costs and Cost-Effectiveness of Targeted, Personalized Risk Information to Increase Appropriate Screening by First-Degree Relatives of People With Colorectal Cancer

Health Education & Behavior ◽

10.1177/1090198119835294 ◽

2019 ◽

Vol 46 (5) ◽

pp. 798-808 ◽

Cited By ~ 1

Author(s):

Penny Reeves ◽

Christopher Doran ◽

Mariko Carey ◽

Emilie Cameron ◽

Robert Sanson-Fisher ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Cost Effectiveness ◽

Usual Care ◽

Economic Evaluations ◽

Screening Guidelines ◽

First Degree Relatives ◽

Life Years ◽

Significant Difference ◽

Quality Adjusted Life

Background. Economic evaluations are less commonly applied to implementation interventions compared to clinical interventions. The efficacy of an implementation strategy to improve adherence to screening guidelines among first-degree relatives of people with colorectal cancer was recently evaluated in a randomized-controlled trial. Using these trial data, we examined the costs and cost-effectiveness of the intervention from societal and health care funder perspectives. Method. In this prospective, trial-based evaluation, mean costs, and outcomes were calculated. The primary outcome of the trial was the proportion of participants who had screening tests in the year following the intervention commensurate with their risk category. Quality-adjusted life years were included as secondary outcomes. Intervention costs were determined from trial records. Standard Australian unit costs for 2016/2017 were applied. Cost-effectiveness was assessed using the net benefit framework. Nonparametric bootstrapping was used to calculate uncertainty intervals (UIs) around the costs and the incremental net monetary benefit statistic. Results. Compared with usual care, mean health sector costs were $17 (95% UI [$14, $24]) higher for those receiving the intervention. The incremental cost-effectiveness ratio for the primary trial outcome was calculated to be $258 (95% UI [$184, $441]) per additional person appropriately screened. The significant difference in adherence to screening guidelines between the usual care and intervention groups did not translate into a mean quality-adjusted life year difference. Discussion. Providing information on both the costs and outcomes of implementation interventions is important to inform public health care investment decisions. Challenges in the application of cost–utility analysis hampered the interpretation of results and potentially underestimated the value of the intervention. Further research in the form of a modeled extrapolation of the intermediate increased adherence effect and distributional cost-effectiveness to include equity requirements is warranted.

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Cost-Effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008?

10.2337/figshare.12081801.v1 ◽

2020 ◽

Author(s):

Karen R. Siegel ◽

Mohammed K. Ali ◽

Xilin Zhou ◽

Boon Peng Ng ◽

Shawn Jawanda ◽

...

Keyword(s):

Smoking Cessation ◽

Cost Effectiveness ◽

Cost Saving ◽

Usual Care ◽

Statin Therapy ◽

Cost Effective ◽

Foot Ulcers ◽

Hypertension Management ◽

Management Interventions ◽

Glycemic Management

Objective: To synthesize updated evidence on the cost-effectiveness (CE) of interventions to manage diabetes, its complications, and comorbidities. Research Design and Methods: We conducted a systematic literature review of studies from high-income countries evaluating the CE of diabetes management interventions recommended by the American Diabetes Association (ADA) and published in English between January 2008 and July 2017. We also incorporated studies from a previous CE review from 1985-2008. We classified the interventions based on their strength of evidence (strong, supportive, or uncertain) and levels of CE: cost-saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). Costs were measured in 2017 U.S. dollars. Results: Seventy-three new studies met our inclusion criteria. These were combined with 49 studies from the previous review to yield 122 studies over the period 1985-2017. A large majority of the ADA-recommended interventions remain cost-effective. Specifically, we found strong evidence that the following ADA-recommended interventions are cost-saving or very cost-effective: (I) Cost-saving: 1) Angiotensin-converting enzyme inhibitor (ACEI)/Angiotensin Receptor Blocker (ARB) therapy for intensive hypertension management compared with standard hypertension management; 2) ACEI/ARB therapy to prevent chronic kidney disease and/or end-stage renal disease in people with albuminuria compared with no ACEI/ARB therapy; 3) comprehensive foot care and patient education to prevent and treat foot ulcers among those at moderate/high risk of developing foot ulcers; 4) telemedicine for diabetic retinopathy screening compared with office screening; and 5) bariatric surgery compared with no surgery for individuals with T2D and obesity (BMI≥30 kg/m2). (II) Very cost-effective: 1) intensive glycemic management (targeting A1c <7%) compared with conventional glycemic management (targeting A1c level of 8-10%) for individuals with newly diagnosed type 2 diabetes (T2D); 2). multi-component interventions (involving behavior change/education and pharmacological therapy targeting hyperglycemia, hypertension, dyslipidemia, microalbuminuria, nephropathy/retinopathy, secondary prevention of CVD with aspirin) compared with usual care; 3) statin therapy compared with no statin therapy for individuals with T2D and history of cardiovascular disease; 4) diabetes self-management education and support compared with usual care; 5) T2D screening every 3 years starting at age 45 years compared with no screening; 6) integrated, patient-centered care compared with usual care; 7) smoking cessation compared with no smoking cessation; 8) daily aspirin use as primary prevention for cardiovascular complications compared with usual care; 9) self-monitoring of blood glucose three times per day compared with once per day among those using insulin; 10) intensive glycemic management compared with conventional insulin therapy for T2D among adults aged 50+ years; and 11) collaborative care for depression compared with usual care. Conclusions: Complementing professional treatment recommendations, our systematic review provides an updated understanding of the potential value of interventions to manage diabetes and its complications and can assist clinicians and payers in prioritizing interventions and health care resources.

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PAIN MANAGEMENT IN CHILDREN WITH ADVANCED CANCER AND DURING END-OF-LIFE CARE

Pediatric Hematology and Oncology ◽

10.3109/08880011003663416 ◽

2010 ◽

Vol 27 (4) ◽

pp. 257-261 ◽

Cited By ~ 13

Author(s):

Stefan J. Friedrichsdorf

Keyword(s):

Pain Management ◽

End Of Life ◽

Advanced Cancer ◽

End Of Life Care ◽

Life Care

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PP230 Safety, Effectiveness, And Cost Effectiveness Of Interventions For Preventing Delirium In Hospitalized Patients

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321001380 ◽

2021 ◽

Vol 37 (S1) ◽

pp. 29-29

Author(s):

Beatriz León-Salas ◽

Renata Linertová ◽

Javier García-García ◽

Pilar Pérez-Ros ◽

Francisco Rivas-Ruiz ◽

...

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Meta Analysis ◽

Hospitalized Patients ◽

Mean Difference ◽

Economic Evaluations ◽

Pharmacological Interventions ◽

Multicomponent Intervention ◽

Safety Effectiveness ◽

Multicomponent Interventions

IntroductionDelirium is a prevalent syndrome in the hospital setting and the elderly are the most affected. The objective was to assess the safety, clinical effectiveness, and cost effectiveness of interventions for preventing delirium among people aged 65 years or older at hospital admission.MethodsA systematic review of available scientific literature (randomized controlled trials) on the safety, effectiveness, and cost effectiveness of the interventions was conducted. The overall effect size for each type of intervention was estimated through a meta-analysis. A cost-effectiveness study in the context of the Spanish National Healthcare System was performed.ResultsForty-nine studies were included for the effectiveness and safety assessment (25 on pharmacological interventions, 12 on perioperative interventions, 2 on non-pharmacological interventions, and 10 on multicomponent interventions). The following interventions reduced delirium incidence relative to usual care or placebo: hypnotics and sedatives (13 studies; risk ratio [RR] 0.54: 95% confidence interval [CI] 0.36–0.80); perioperative interventions aimed at limiting opioid use (two studies; RR 0.50, 95% CI: 0.29–0.86); controlling the intensity of general anesthesia (three studies; RR 0.77, 95% CI: 0.59–0.99); and multicomponent interventions (10 studies; RR 0.62, 95% CI: 0.54–0.72). In addition, multicomponent interventions reduced the duration (mean difference −1.18, 95% CI: −1.95 - −0.40) and severity of delirium (standardized mean difference −0.98, 95% CI: −1.46 - −0.49), while dexmedetomidine reduced the duration of delirium (mean difference −0.70, 95% CI: −1.03 - −0.37).The economic analysis of a multicomponent preventive intervention estimated an average cost of EUR7,282 per patient, which was EUR140 per patient more expensive than usual care. The incremental cost-effectiveness ratio was EUR21,391 per quality-adjusted life-year, which is below the acceptability threshold used in Spain. The literature review yielded two economic evaluations that estimated the cost effectiveness of a multicomponent intervention in the United Kingdom and found that the multicomponent intervention was a dominant strategy.ConclusionsThis meta-analysis suggests that multicomponent interventions and dexmedetomidine are effective in reducing the incidence of delirium in hospitalized patients and that multicomponent interventions could be a cost-effective strategy in Spain.

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Cost-Effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008?

10.2337/figshare.12081801 ◽

2020 ◽

Author(s):

Karen R. Siegel ◽

Mohammed K. Ali ◽

Xilin Zhou ◽

Boon Peng Ng ◽

Shawn Jawanda ◽

...

Keyword(s):

Smoking Cessation ◽

Cost Effectiveness ◽

Cost Saving ◽

Usual Care ◽

Statin Therapy ◽

Cost Effective ◽

Foot Ulcers ◽

Hypertension Management ◽

Management Interventions ◽

Glycemic Management

Objective: To synthesize updated evidence on the cost-effectiveness (CE) of interventions to manage diabetes, its complications, and comorbidities. Research Design and Methods: We conducted a systematic literature review of studies from high-income countries evaluating the CE of diabetes management interventions recommended by the American Diabetes Association (ADA) and published in English between January 2008 and July 2017. We also incorporated studies from a previous CE review from 1985-2008. We classified the interventions based on their strength of evidence (strong, supportive, or uncertain) and levels of CE: cost-saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). Costs were measured in 2017 U.S. dollars. Results: Seventy-three new studies met our inclusion criteria. These were combined with 49 studies from the previous review to yield 122 studies over the period 1985-2017. A large majority of the ADA-recommended interventions remain cost-effective. Specifically, we found strong evidence that the following ADA-recommended interventions are cost-saving or very cost-effective: (I) Cost-saving: 1) Angiotensin-converting enzyme inhibitor (ACEI)/Angiotensin Receptor Blocker (ARB) therapy for intensive hypertension management compared with standard hypertension management; 2) ACEI/ARB therapy to prevent chronic kidney disease and/or end-stage renal disease in people with albuminuria compared with no ACEI/ARB therapy; 3) comprehensive foot care and patient education to prevent and treat foot ulcers among those at moderate/high risk of developing foot ulcers; 4) telemedicine for diabetic retinopathy screening compared with office screening; and 5) bariatric surgery compared with no surgery for individuals with T2D and obesity (BMI≥30 kg/m2). (II) Very cost-effective: 1) intensive glycemic management (targeting A1c <7%) compared with conventional glycemic management (targeting A1c level of 8-10%) for individuals with newly diagnosed type 2 diabetes (T2D); 2). multi-component interventions (involving behavior change/education and pharmacological therapy targeting hyperglycemia, hypertension, dyslipidemia, microalbuminuria, nephropathy/retinopathy, secondary prevention of CVD with aspirin) compared with usual care; 3) statin therapy compared with no statin therapy for individuals with T2D and history of cardiovascular disease; 4) diabetes self-management education and support compared with usual care; 5) T2D screening every 3 years starting at age 45 years compared with no screening; 6) integrated, patient-centered care compared with usual care; 7) smoking cessation compared with no smoking cessation; 8) daily aspirin use as primary prevention for cardiovascular complications compared with usual care; 9) self-monitoring of blood glucose three times per day compared with once per day among those using insulin; 10) intensive glycemic management compared with conventional insulin therapy for T2D among adults aged 50+ years; and 11) collaborative care for depression compared with usual care. Conclusions: Complementing professional treatment recommendations, our systematic review provides an updated understanding of the potential value of interventions to manage diabetes and its complications and can assist clinicians and payers in prioritizing interventions and health care resources.

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Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter?

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/hjr.0b013e328304fec1 ◽

2008 ◽

Vol 15 (5) ◽

pp. 608-615 ◽

Cited By ~ 19

Author(s):

Neil Oldridge ◽

William Furlong ◽

Anthony Perkins ◽

David Feeny ◽

George W. Torrance

Keyword(s):

Cost Effectiveness ◽

Cardiac Rehabilitation ◽

Incremental Cost ◽

Usual Care ◽

Randomized Trial ◽

Patient Preferences ◽

Secondary Analysis ◽

Cost Effective ◽

Economic Evaluations ◽

Life Years

Background Few healthcare economic evaluations, and none in cardiac rehabilitation, report results based on both community and patient preferences for health outcomes. We published the results of a randomized trial of cardiac rehabilitation after myocardial infarction in 1994 in which preferences were measured using both perspectives but only patient preferences were reported. This secondary analysis uses both types of preference measurements. Methods We collected community Quality of Well-Being (QWB) and patient Time Trade-off (TTO) preference scores from 188 patients (rehabilitation, n = 93; usual care, n = 95) on entry into the trial, at 2 months (end of the intervention) and again at 4, 8, and 12 months. Mean preference scores over the 12-month follow-up study period, estimates of quality-adjusted life years (QALYs) gained per patient, incremental cost-effectiveness ratios [costs inflated to 2006 US dollars] and probabilities of the cost-effectiveness of rehabilitation for costs per QALY up to US$100 000 are reported. Results Mean QWB preference scores were lower ( P < 0.01) than the corresponding mean TTO preference scores at each assessment point. The 12-month changes in mean QWB and TTO preference scores were large and positive ( P < 0.001) with rehabilitation patients gaining a mean of 0.011 (95% confidence interval, –0.030 to +0.052) more QWB-derived QALYs, and 0.040 (–0.026, 0.107) more TTO-derived QALYs, per patient than usual care patients. The incremental cost-effectiveness ratio for QWB-derived QALYs was estimated at $60270/QALY (about €50 600/QALY) and at $16580/QALY (about €13 900/QALY) with TTO-derived QALYs. With a willingness to spend $100 000/QALY, the probability of rehabilitation being cost-effective is 0.58 for QWB-derived QALYs and 0.83 for TTO-derived QALYs. Conclusion This secondary analysis of data from a randomized trial indicates that cardiac rehabilitation is cost-effective from a community perspective and highly cost-effective from the perspective of patients.

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