EU-CaRE study: Could exercise-based cardiac telerehabilitation also be cost-effective in elderly?

• Published in: International journal of cardiology 2021-10, Vol.340, p.1-6
• Main Authors: Scherrenberg, M., Zeymer, U., Schneider, S., Van der Velde, A.E., Wilhelm, M., Van’t Hof, A.W.J., Kolkman, E., Prins, L.F., Prescott, E., Iliou, M.C., Peña-Gil, C., Ardissino, D., De Kluiver, E.P., Dendale, P.
• Format: Article
• Language: English
• Subjects: Cardiac rehabilitation; Coronary artery disease; Digital health; Elderly; Mobile health; Secondary prevention; Telerehabilitation
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.08.024

The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease. Unfortunately, the participation rates across Europe remain low, especially in elderly. The EU-CaRE RCT investigated the effectiveness of a home-based mobile CR programme in elderly patients that were not willing to participate in centre-based CR. The initial study concluded that a 6-month home-based mobile CR programme was safe and beneficial in improving VO2peak when compared with no CR. To assess whether a 6-month guided mobile CR programme is a cost-effective therapy for elderly patients who decline participation in CR. Patients were enrolled in a multicentre randomised clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. A total of 179 patients who declined participation in centre-based CR and met the inclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programs in the Elderly trial. The data of patients (n = 17) that were lost in follow-up were excluded from this analysis. The intervention (n = 79) consisted of 6 months of mobile CR programme with telemonitoring, and coaching based on motivational interviewing to stimulate patients to reach exercise goals. Control patients did not receive any form of CR throughout the study period. The costs considered for the cost-effectiveness analysis of the RCT are direct costs 1) of the mobile CR programme, and 2) of the care utilisation recorded during the observation time from randomisation to the end of the study. Costs and outcomes (utilities) were compared by calculation of the incremental cost-effectiveness ratio. The healthcare utilisation costs (P = 0.802) were not significantly different between the two groups. However, the total costs were significantly higher in the intervention group (P = 0.040). The incremental cost-effectiveness ratio for the primary endpoint VO2peak at 6 months was €1085 per 1-unit [ml/kg/min] improvement in change VO2peak and at 12 months it was €1103 per 1 unit [ml/kg/min] improvement in change VO2peak. Big differences in the incremental cost-effectiveness ratios for the primary endpoint VO2peak at 6 months and 12 months were present between the adherent participants and the non-adherent participants. From a health-economic point of view the home-b