Sandra Spronk MSc, Presenter: Nothing to Disclose

Johanna L. Bosch PhD, Abstract Co-Author: Nothing to Disclose

Connie Ryjewski, Abstract Co-Author: Nothing to Disclose

Guido C. Kaandorp MSc, Abstract Co-Author: Nothing to Disclose

John V. White MD, Abstract Co-Author: Nothing to Disclose

M. G. Myriam Hunink MD, PhD, Abstract Co-Author: Grant, W. L. Gore & Associates, Inc

Patients with coronary artery disease (CAD) frequently have peripheral arterial disease (PAD), which hinders their cardiac rehabilitation program because they are unable to achieve their target heart rate. Purpose of this study was to evaluate the relative cost-effectiveness from the societal perspective of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with CAD undergoing cardiac rehabilitation.

We developed a Markov decision model to compare the following treatment strategies: 1. Cardiac rehabilitation; 2. Diagnostic work-up if cardiac rehabilitation fails followed by revascularization for PAD if needed; 3. Diagnostic work-up for PAD in all patients prior to cardiac rehabilitation and revascularization for PAD if needed; 4. A combined cardiovascular rehabilitation program. The best-available evidence was retrieved from the literature and combined with primary data from 231 patients. Quality-adjusted-life years (QALYs), life-time costs, incremental cost-effectiveness ratios (ICER), and incremental net health benefits (iNHB) were calculated.

The cardiovascular rehabilitation was the most attractive with an ICER of $16,461 per QALY gained and an iNHB of 0.06 compared to current practice. In an analysis without this strategy, a diagnostic work-up if cardiac rehabilitation fails followed by revascularization for PAD if needed was most beneficial with an ICER of $49,468 per QALY gained and an iNHB of 0.02 compared to current practice.

A combined cardiovascular rehabilitation program, or a diagnostic work-up in patients who fail cardiac rehabilitation followed by revascularization for PAD if needed, could potentially decrease secondary cardiac events and save society millions of dollars.

Patients with coronary artery disease frequently have peripheral arterial disease, which hinders the cardiac rehabilitation program because patients are unable to achieve their target heart rate.

Spronk, S, Bosch, J, Ryjewski, C, Kaandorp, G, White, J, Hunink, M, Cost-effectiveness of New Cardiac and Vascular Rehabilitation Strategies for Patients with Coronary Artery Disease.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5010511.html