Circulation: Exercise training for HF patients shifts costs to patients

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The cost of exercise training was relatively low for the healthcare system, but patients incurred significant time costs, based on an economic sub-study of HF-ACTION, published online June 15 in Circulation: Cardiovascular Quality and Outcomes. In this economic evaluation, the researchers said there was little systematic benefit in terms of overall medical resource use with this intervention.

HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) assigned 2,331 outpatients with medically stable heart failure to exercise training or usual care. Shelby D. Reed, PhD, from the Duke Clinical Research Institute in Durham, N.C., and colleagues compared medical resource use and costs incurred by these patients during follow-up.

The researchers collected extensive data on medical resource use and hospital bills throughout the trial for estimates of direct medical costs. They estimated intervention costs using patient-level trial data, administrative records and published unit costs.

During 2.5 years of follow-up, there were 2,297 hospitalizations in the exercise group and 2,332 in the usual care group, according to the authors. The mean number of inpatient days was 13.6 in the exercise group and 15 in the usual care group. Other measures of resource use were similar between groups, except for trends indicating that fewer patients in the exercise group underwent high-cost inpatient procedures, they wrote.

Reed and colleagues estimated the total direct medical costs per participant was $50,857 in the exercise group and $56,177 in the usual care group. The direct cost of exercise training was an estimated $1,006. Patient time costs were an estimated $5,018.

Based on point estimates, the researchers found that the mean unadjusted direct medical costs in the exercise training group were $4,300 lower than in the usual care group. However, with patient time, travel and parking costs, the cost difference disappeared and there was no statistically significant difference in costs between the groups.

The estimates of cost and cost effectiveness were influenced by the difference in the number of patients who underwent high-cost inpatient procedures, particularly heart transplantations and left ventricular assist device and ICD implantations, Reed and colleagues reported. The finding that significantly fewer patients in the exercise training group received an ICD during the study may be attributable to the larger number of patients in the exercise training group who had an ICD at baseline (42.3 percent) compared with the usual care group (38.2 percent).

The authors concluded that relative to the overall cost of heart failure to the healthcare system, costs associated with exercise training are small, but much are incurred by the patient.