Article Text

Download PDFPDF

Cost-effectiveness of cardiac rehabilitation: a systematic review
  1. Gemma E Shields1,
  2. Adrian Wells2,3,
  3. Patrick Doherty4,
  4. Anthony Heagerty5,
  5. Deborah Buck1,
  6. Linda M Davies1
  1. 1 Centre for Health Economics, University of Manchester, Manchester, UK
  2. 2 School of Psychological Sciences, University of Manchester, Manchester, UK
  3. 3 Manchester Mental Health and Social Care NHS Trust, Manchester, UK
  4. 4 Department of Health Sciences, University of York, York, UK
  5. 5 Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
  1. Correspondence to Gemma E Shields, Centre for Health Economics, University of Manchester, Manchester M13 9PL, UK; gemma.shields{at}


Patients may be offered cardiac rehabilitation (CR), a supervised programme often including exercises, education and psychological care, following a cardiac event, with the aim of reducing morbidity and mortality. Cost-constrained healthcare systems require information about the best use of budget and resources to maximise patient benefit. We aimed to systematically review and critically appraise economic studies of CR and its components. In January 2016, validated electronic searches of the National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment, PsycINFO, MEDLINE and Embase databases were run to identify full economic evaluations published since 2001. Two levels of screening were used and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed using the NHS EED handbook and Drummond checklist. The majority of studies concluded that CR was cost-effective versus no CR (incremental cost-effectiveness ratios (ICERs) ranged from $1065 to $71 755 per quality-adjusted life-year (QALY)). Evidence for specific interventions within CR was varied; psychological intervention ranged from dominant (cost saving and more effective) to $226 128 per QALY, telehealth ranged from dominant to $588 734 per QALY and while exercise was cost-effective across all relevant studies, results were subject to uncertainty. Key drivers of cost-effectiveness were risk of subsequent events and hospitalisation, hospitalisation and intervention costs, and utilities. This systematic review of studies evaluates the cost-effectiveness of CR in the modern era, providing a fresh evidence base for policy-makers. Evidence suggests that CR is cost-effective, especially with exercise as a component. However, research is needed to determine the most cost-effective design of CR.

  • cardiac rehabilitation
  • health care economics
  • systemic review

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from


  • Contributors GES, AW, LMD formulated the search questions, GES and DB conducted the literature search with oversight from LMD. GES wrote the first draft of the manuscript. DB, AW, PD, AH and LMD contributed to the final writing of the paper. AW is the chief investigator.

  • Funding This publication summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (grant reference no RP-PG-1211-20011).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Search terms used for this study are provided as supplementary information accompanying this paper. The drummond critical appraisal checklists are also included in the supplementary material. Researchers may request the full data extraction tables in full by contacting the corresponding author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.