Cost-Effectiveness of Cardiac Rehabilitation in Older Adults With Coronary Heart Disease

Donald S. Shepard, Shehreen Zakir, Diann E. Gaalema, Philip A. Ades

Research output: Contribution to journalArticlepeer-review


Purpose: While cardiac rehabilitation (CR) is recommended and effective following acute cardiac events, it remains underutilized, particularly in older adults. A study of 601 099 Medicare beneficiaries ≥65 yr hospitalized for coronary heart disease compared 5-yr mortality in users and nonusers of CR. Using instrumental variables (IV), CR improved mortality by 8.0% (P < .001). A validation analysis based on 70 040 propensity-based (PB) matched pairs gave a similar gain (8.3%, P < .0001). The present cost-effectiveness analysis builds on these mortality results. Methods: Using the framework of the Second Panel on Cost-Effectiveness Analysis, we calculated the incremental cost-effectiveness ratio (ICER) gained due to CR. We accessed the costs from this cohort, inflated to 2022 prices, and assessed the relationship of quality-adjusted life years (QALY) to life years from a systematic review. We estimated the ICER of CR by modeling lifetime costs and QALY from national life tables using IV and PB. Results: Using IV, CR added 1.344 QALY (95% CI, 0.543-2.144) and $40 472 in costs over the remaining lifetimes of participants. The ICER was $30 188 (95% CI, $18 175-$74 484)/QALY over their lifetimes. Using the PB analysis, the corresponding lifetime values were 2.018 (95% CI, 1.001-3.035) QALY, $66 590, and an ICER of $32 996 (95% CI, $21 942-$66 494)/QALY. Conclusions: Cardiac rehabilitation was highly cost-effective using guidelines established by the World Health Organization and the US Department of Health and Human Services. The favorable clinical effectiveness and cost-effectiveness of CR, along with low use by Medicare beneficiaries, support the need to increase CR use.

Original languageEnglish (US)
Pages (from-to)107-114
Number of pages8
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number2
StatePublished - Mar 1 2024
Externally publishedYes


  • cardiac rehabilitation
  • coronary heart disease
  • cost-effectiveness
  • Medicare
  • mortality
  • older adults

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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