Cost-utility analysis of home-based telerehabilitation compared with centre-based rehabilitation in patients with heart failure

Background: Whilst home-based telerehabilitation has been shown non-inferior to traditional centre-based rehabilitation in patients with chronic heart failure, its economic sustainability remains unknown. This study aimed to investigate the cost-utility of a home-based telerehabilitation program. Methods: A comparative, trial-based, incremental cost-utility analysis was conducted from a health care provider's perspective. We collected data as part of a multi-centre, two-arm, non-inferiority, randomised controlled trial with 6 months follow-up. There were 53 participants randomised to either a telerehabilitation program (consisting of 12 weeks of group-based exercise and education delivered into the home via online videoconferencing) or a traditional centre-based program. Health care costs (including personnel, equipment and hospital readmissions due to heart failure) were extracted from health system records, and calculated in Australian dollars using 2013 as the base year. Health utilities were measured using the EuroQol five-dimensional (EQ-5D) questionnaire. Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs and utility differences were plotted on a cost-effectiveness plane. Results: Total health care costs per participant were significantly lower in the telerehabilitation group (-$1,590, 95% CI: −2,822, −359) during the 6 months. No significant differences in quality-adjusted life years (0, 95% CI: −0.06, 0.05) were seen between the two groups. Conclusions: Heart failure telerehabilitation appears to be less costly and as effective for the health care provider as traditional centre-based rehabilitation.