Sir,—I thank Taylor and Kirby1for drawing attention to the cost effectiveness of cardiac rehabilitation but feel that the issue should be opened to further debate.

Cardiac rehabilitation, like any therapeutic intervention, should of course be subjected to economic evaluation. However, it is not sufficient to focus solely on effectiveness measures without taking into consideration issues such as health related quality of life (HRQOL).2 Indeed, in reporting the study by Oldridgeet al 3 the authors have highlighted this point. While the adaptation of the 1988 Oldridge data to current UK cost-utility figures for selected cardiovascular interventions can be justified, interpretation of the figures may be misleading. Of particular note is the fact that if HRQOL factors are ignored then the current £6900/quality adjusted life year gained …