Patients with heart failure benefit from exercise and rehabilitation because these interventions increase exercise capacity, improve quality of life, and reduce the risk of cardiac related hospital readmissions. The ability to receive cardiac rehabilitation remotely grants greater access to these vital care interventions. Home based telerehabilitation has been proven to be as effective as in-person rehabilitation, yet the economic outcomes are unknown. A recent study explored this question by performing a cost utility analysis of a home based telerehabilitation program for patients with heart failure.
Benefits of Telerehabilitation
Telerehabilitation models can help patients overcome barriers to healthcare and can subsequently expand healthcare access for patients with heart failure and other conditions. Furthermore, there is evidence to support the use of telerehabilitation among patients with chronic conditions or physical disabilities. For example, a systematic review reported a 71% success rate of telerehabilitation among patients with physical disabilities.
Additionally, telerehabilitation has been demonstrated to be as effective as traditional rehabilitation programs in cardiac and pulmonary rehabilitation programs. In fact, cardiac patients participating in telerehabilitation have been found to experience a lower risk of adverse events and cardiac related hospital readmissions, while demonstrating a higher adherence to physical activity guidelines compared to usual care.
The Economics of Telerehabilitation
While the benefits of telerehabilitation are widely understood, the economic sustainability of this alternative care model remains unknown. A recent study sought to explore the economics of telerehabilitation by performing a cost-utility analysis of a home-based telerehabilitation program for patients with heart failure. The study was part of a larger randomized controlled trial investigating the effects of a cardiac telerehabilitation program in Queensland, Australia. The aim of the economic analysis was to compare the cost-effectiveness of a home-based telerehabilitation program to a traditional center-based rehabilitation program for patients with heart failure.
A total of 53 patients participated in the study. 24 patients were randomized to the telerehabilitation intervention, which consisted of 12 weeks of group-based exercise and education delivered via video conferencing. Patients received these interventions in their homes two times per week and each session was supervised by a physical therapist and a nurse. The telerehabilitation program delivered care to up to four participants at a time.
29 patients were randomized to the control group. These patients participated in a traditional in-person rehabilitation program. The program was the same frequency and duration as the telerehabilitation group and was also led by a physical therapist and nurse.
Telerehabilitation is Cost Effective for Patients with Heart Failure
The authors of the study found that the total healthcare costs per participant were significantly lower in the telerehabilitation group over 6 months (during the 3 month program period and 3 months follow up). Healthcare costs per participant, including heart failure readmission costs, were $1,590 (Australian dollars) less in the telerehabilitation group than in the control group. The authors attribute the cost increase in the control group to higher equipment and personnel costs, as well as a higher number of heart failure related readmissions in this group.
The authors also note that the reported telerehabilitation cost-savings may be under-represented because they did not include patient transportation costs in the analysis, which were surely lower in the intervention group.
Not only was the 12-week telerehabilitation program less costly than the center based program, it was also just as effective in improving patient outcomes. As a result, the authors of this study concluded that healthcare providers should seriously consider offering this type of alternative care for patients with heart failure and other chronic conditions.
Hwang R, Morris NR, Mandrusiak A, et al. Cost-utility Analysis of Home-based Telerehabilitation Compared with Centre-based Rehabilitation in Patients with Heart Failure. Heart Lung Circ. 2018 Dec 2. pii: S1443-9506(18)31995-4.