Cost and effectiveness assessment of cardiac rehabilitation for dialysis patients following coronary bypass

• Authors: Yijian Huang, Emory University; Rebecca Zhang, Emory University; Steven D Culler, Emory University; Nancy Kutner, Emory University
• Journal Title: Kidney International
• Volume: Volume 74, Number 8
• Publisher: International Society of Nephrology | 2008-10, Pages 1079-1084
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1038/ki.2008.381
• Subjects: Biology, Biostatistics; Health Sciences, Public Health; Health Sciences, Health Care Management; Health Sciences, Rehabilitation and Therapy
• Keywords: cardiac rehabilitation; end-stage renal disease; hemodialysis; coronary artery bypass grafting; economic evaluation; cost-effective

Abstract

Dialysis patients have a high risk of cardiovascular disease. In the general population, cardiac rehabilitation is recommended as a standard component of care and is covered by Medicare for patients who have undergone coronary artery bypass grafting (CABG). Previous investigation demonstrated survival benefit of cardiac rehabilitation in dialysis patients. This study investigated its impact on Medicare expenditure and its cost effectiveness. A cohort of 4,324 end-stage renal disease (ESRD) patients who initiated chronic hemodialysis and underwent CABG between 1998 and 2004 was selected from the United States Renal Data System. Cardiac rehabilitation was defined by Current Procedural Terminology codes for monitored and nonmonitored exercise in Medicare claims data. Medicare expenditure included inpatient and outpatient claims with cost adjusted to 1998 dollars. At 42 months of follow-up after a 6-month entry period following CABG hospitalization discharge, cardiac rehabilitation at baseline was associated with higher cumulative Medicare expenditure, incurring a statistically nonsignificant increment of $2,904 (95% CI: −7,028, 11,940). During the same period, cardiac rehabilitation was significantly associated with longer cumulative lifetime, having an incremental benefit of 76 days (95% CI: 22, 129). The incremental cost-effectiveness ratio was $13,887 per year of life saved, suggesting that cardiac rehabilitation is highly cost-effective in ESRD patients following CABG.