Authors

  1. Oldridge, Neil B.
  2. Furlong, William

Article Content

Comparative economic evaluations with both indirect community and direct patient preferences are seldom reported in the same study in patients with the same condition when estimating the quality-adjusted life years (QALYs) gained with an intervention. The objectives of this secondary analysis were to estimate incremental cost-utility ratios (ICURs in 2005 US dollars) using both indirect community (Quality of Well-being, QWB) and direct patient (Time Trade-Off, TTO) preferences in a randomized clinical trial of cardiac rehabilitation (n = 93 to cardiac rehabilitation; n = 95 to usual care) and to present both QWB and TTO cost-utility planes and cost-utility acceptability curves as a way for informing decisions about the provision of cardiac rehabilitation after myocardial infarction. The QWB-derived estimates demonstrate a modest amount of quality-adjusted gain per patient (0.011 QALYs) at a cost of $73,630/QALY gained with a .41 probability of cardiac rehabilitation being cost-effective at the conventional threshold of $50,000/QALY. The TTO-derived estimates demonstrate larger, but not significantly different, estimates of quality-adjusted gain per patient (0.040 QALYs) at a lower cost of $20,750/QALY gained with a .74 probability of rehabilitation being cost-effective at the conventional threshold of $50,000/QALY gained. The cost-utility analyses suggest that the added costs of cardiac rehabilitation may be worth the added benefits from the policy perspective and probably are worth the health gains from the clinician/patient decision-makers' perspectives. The cost-utility planes and cost-utility acceptability curves described in this study complement those recently published in other studies.