SYSTEMATIC REVIEW   Open access

European Journal of Physical and Rehabilitation Medicine 2023 April;59(2):248-58

DOI: 10.23736/S1973-9087.23.07773-0

Copyright © 2023 THE AUTHORS

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language: English

The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review

Ladislav BATALIK ^{1, 2} ✉, Katerina FILAKOVA ^{1, 3}, Michaela SLADECKOVA ^{1, 2, 4}, Filip DOSBABA ¹, Jingjing SU ⁵, Garyfallia PEPERA ⁶

¹ Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic; ² Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic; ³ Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic; ⁴ Department of Neurology, University Hospital of Brno, Brno, Czech Republic; ⁵ School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; ⁶ School of Health Sciences, Department of Physiotherapy, Clinical Exercise Physiology and Rehabilitation Laboratory, University of Thessaly, Lamia, Greece

INTRODUCTION: Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets lead to cost-effectiveness analyses before implementation. They are appropriate in cases where there is evidence that the compared intervention provides a similar health benefit to usual care. This systematic review aimed to compare the cost-effectiveness of exercise-based telehealth CR interventions compared to standard exercise-based CR.
EVIDENCE ACQUISITION: PubMed and Web of Science databases were systematically searched up to August 2022 to identify randomized controlled trials assessing patients undergoing telehealth CR. The intervention was compared to standard CR protocols. The primary intent was to identify the cost-effectiveness. Interventions that met the criteria were home-based telehealth CR interventions delivered by information and communications technology (telephone, computer, internet, or videoconferencing) and included the results of an economic evaluation, comparing interventions in terms of cost-effectiveness, utility, costs and benefits, or cost-minimization analysis. The systematic review protocol was registered in the PROSPERO Registry (CRD42022322531).
EVIDENCE SYNTHESIS: Out of 1525 identified studies, 67 articles were assessed for eligibility, and, at the end of the screening process, 12 studies were included in the present systematic review. Most studies (92%) included in this systematic review found strong evidence that exercise-based telehealth CR is cost-effective. Compared to CBCR, there were no major differences, except for three studies evaluating a significant difference in average cost per patient and intervention costs in favor of telehealth CR.
CONCLUSIONS: Telehealth CR based on exercise is as cost-effective as CBCR interventions. Funding telehealth CR by third-party payers may promote patient participation to increase overall CR utilization. High-quality research is needed to identify the most cost-effective design.

KEY WORDS: Telemedicine; Cardiac rehabilitation; Costs and cost analysis; Exercise