Cost-effectiveness of cardiac rehabilitation after myocardial infarction.

BACKGROUND Cardiac rehabilitation is commonly prescribed after myocardial infarction (MI) to coordinate exercise training and secondary preventive services. Cost-effectiveness analysis allows the quantitative comparison of the relative economic worth of cardiac rehabilitation in relation to other common interventions. METHODS The cost-effectiveness of cardiac rehabilitation, in dollars per year of life saved ($/YLS), was calculated by combining published results of randomized trials of cardiac rehabilitation on mortality rates, epidemiologic studies of long-term survival in the overall postinfarction population, and studies of patient charges for rehabilitation services and averted medical expenses for hospitalizations after rehabilitation. RESULTS Cardiac rehabilitation participants experienced an incremental life expectancy of 0.202 years during a 15-year period. In 1988, the average cost of rehabilitation and exercise testing was $1,485, partially offset by averted cardiac rehospitalizations of $850 per patient. A cost-effectiveness value of 2,130 $/YLS was determined for the late 1980s, projected to a value of 4,950 $/YLS for 1995. A sensitivity analysis supports the study results. CONCLUSIONS Compared with other post-MI treatment interventions, cardiac rehabilitation is more cost-effective than thrombolytic therapy, coronary bypass surgery, and cholesterol lowering drugs, though less cost-effective than smoking cessation programs. Cardiac rehabilitation should stand alongside these therapies as standard of care in the post-MI setting.