Cost-effectiveness of cardiac rehabilitation versus usual care in Chile




Poster session 3 Friday: Evidence Tools / Evidence synthesis - creation, publication and updating in the digital age


Friday 15 September 2017 - 12:30 to 14:00


All authors in correct order:

Seron P1, Gaete M1, Oliveros M1, Roman C2, Bustos L1, Velazquez M1, Lanas F1, Rojas R2
1 Universidad de La Frontera, Chile
2 Pontificia Universidad Católica, Chile
Presenting author and contact person

Presenting author:

Pamela Seron

Contact person:

Abstract text
Background: The secondary prevention plays a fundamental role in patients after a cardiovascular event. One of the most effective interventions is Cardiac Rehabilitation (CR), but in Chile, this service is given only to 5% of candidate patients, mainly in urban areas and in the private health system, apparently due to its higher costs in comparison with usual care.

Objectives: To assess the cost-effectiveness of CR compared with usual care in survivors from an Acute Coronary Syndrome (ACS) from the perspective of the public health system in Chile.

Methods: A Markov Model was developed with 5 health states: ACS survivor, Second ACS, Complications, General Mortality, and CV Mortality. The transition probabilities between health states for usual care and corresponding relative risk (RR) for CR where obtained from a Cochrane systematic review. Health benefits were expressed as utilities and measured trough the EQ-5D-3L survey. Costs for each health state were identified and quantified from the national cost verification study and in some cases from focus surveys. The CR cost was estimated by a micro-costing system. Time horizon was lifetime and discount rate for both costs and outcomes was 3% per year. Deterministic and probabilistic analysis was performed with TreeAge Pro ©. Structural uncertainty was managed by designing of 3 scenarios: CR as actually is delivered in a specific public health centre (San José Model); CR as is recommended by South-American Guidelines (South-American Model), and CR as is proposed for low-resource settings (Low-Resource Model).

Results: Cost-effectiveness results of CR versus usual care showed an incremental cost-effectiveness ratio (ICER) for San José Model of $ 152,73 USD, for South-American Model of $ 358,70 USD, and for Low Resource Model of $ 128,92 USD. The estimated cost of CR for one entire programme for one patient was from $ 58,14 USD in the Low-Resource Model to $ 490,12 USD in the South-American Model.

Conclusions: Considering a cost effectiveness threshold of 1 GDP per capita (about $ 20.000 USD) the CR is highly cost effective for the public health system in Chile.