Outpatient cardiac rehabilitation, part VII: Economic evaluation
Project team: Heinz Tüchler
Duration: April 2015 – June 2016
Publication: LBI-HTA Project report N0. 89 https://eprints.aihta.at/1102/
Suggested by: Association of Austrian Health Insurance Providers (HVB)
Commissioned by the HVB, the LBI-HTA conducted a multi-centric, prospective cohort study with two study groups for evaluating the outpatient cardiac phase III rehabilitation. The outpatient phase III rehabilitation is an additive offer to the phase II rehabilitation. Therefore, the question of their clinical and health-related relevance plus costs and potential costs savings (e.g., less use of services) is important. The comparison of health-related effects and costs as part of a health economic evaluation can be used as decision support for reimbursement authorities, like the HVB.
Aim of the project:
The clinical evaluation of the outpatient cardiac phase III rehabilitation shall be supplemented by an economic evaluation. The effects of patients who completed the phase III rehabilitation will be compared to those who exclusively completed phase II (and therefore did not receive phase III).
1) What are the costs for rehabilitation services carried out on average per participant and in total of the individual study groups?
2) What are the costs for the services listed below that occur in the intervention group and in the control group up to 18 months after completion of the Phase II or Phase II and Phase III phase of rehabilitation?
* Costs for physicians
* Costs for outpatient therapeutic services
* Costs for drugs
* Costs for repeated rehabilitation
3) What are the costs for inpatient services in the intervention group compared with the control group in an observational period of up to 18 months after completion of phase II rehabilitation?
4) What are the health effects in relation to rehabilitation costs and consequential costs in each of the study groups?
A) Study type of economic evaluation
For answering the research questions a cost-consequence analysis will be used. This is a type of cost-effectiveness analysis in which the costs and health effects of the rehabilitation are shown in quantitative terms.
B) Control intervention and study population
The intervention group is that study group in which participants received phase III rehabilitation. In the control group are those participants who did not receive phase III rehabilitation. Both groups will be compared with each other.
The cost calculations will be performed from the perspective of public reimbursement authorities.
D) Time horizon
The time horizon for the economic evaluation corresponds to that of the clinical trial. Time of entry into the study is the completion of phase II rehabilitation.
E) Assessment of health effect
The health effect is illustrated by the results of the clinical study by using the primary and secondary outcomes.
F) Evaluation of resource use and costs
- The use of resources for phase III rehabilitation (number and duration of rehabilitation stays), the use of resources / services after phase II rehabilitation (e.g., drugs) and the number/duration of sick certificates and early retirements are investigated in the clinical trial.
- The cost calculations are based on reimbursed rates per service.
- The average costs per inpatient and outpatient rehabilitation will be transmitted by the HVB in cooperation with the rehabilitation centres.
- Average rates for outpatient services are provided by the Association of Austrian Health Insurance Providers.
- Average costs for drugs (and dosages) are provided by the Association of Austrian Health Insurance Providers.
- Costs of hospital services are based on lump sums (provided by HVB) used for the individual reasons of inpatient admissions.
Due to the short time horizon of the study, results will not be discounted.
H) Sensitivity analysis
Uncertain parameters will be optionally varied within the scope of simple (deterministic) sensitivity analyses.
May-July 2015: request for cost data provided by HVB
Aug.-Oct. 2015: data analysis
Sept.-Nov. 2015: drafting of the report
Dec. 2015: internal and extern