Pneumologie 2013; 67 - V78
DOI: 10.1055/s-0033-1334502

Cost-effectiveness analysis of rehabilitation with exercise and respiratory therapy in pulmonary hypertension

N Ehlken 1, C Verduyn 2, H Tiede 3, G Stähler 4, J Juenger 5, C Opitz 6, H Klose 7, H Wilkens 8, S Rosenkranz 9, M Halank 10, E Grünig 1
  • 1Thoraxklinik Heidelberg
  • 2Mapi Consultancy Houten
  • 3Medizinische Klink II, Abteilung Pneumologie, UKGM, Standort Gießen
  • 4Klinik Löwenstein, Medizinische Klinik I Pneumologie und Beatmungsmedizin, Löwenstein
  • 5Abteilung für Psychosomatik, Universität Heidelberg
  • 6Abteilung für Kardiologie, DRK Kliniken Berlin Köpenick
  • 7Universitätsklinikum Hamburg-Eppendorf, Sektion Pneumologie, Gebäude O24, Hamburg
  • 8Universitätsklinikum des Saarlandes, Medizinische Klinik V, Homburg
  • 9Department of Cardiology, University of Cologne
  • 10Carl Gustav Carus Universitätsklinikum Dresden

Background: Exercise training as add-on to medical therapy has shown to improve exercise capacity, quality of life and possibly prognosis in patients with severe chronic pulmonary hypertension (PH). Aim of this study was to analyze the impact of exercise training on health-care costs in PH.

Methods: Estimated health care costs have been compared between patients with severe PH who received exercise training in addition to optimized medical therapy (training-group) and an age-gender matched control group who received medical therapy only. Cost-analysis was based on a cost-estimation model and included the estimated costs for baseline and follow-up visits and all PH-related health-care events which occurred within the follow-up period. Time to clinical worsening and survival were assessed by phone and/or control visits.

Results: At baseline patients of the training-group (n = 58) and control-group (n = 48) did not differ in age, gender, WHO-functional class, 6-minute walking distance, hemodynamic parameters or PH-targeted medication. During a follow-up period of 24 ± 12 months, patients of the training group had significantly better survival rates at 1 and 3 years and less (worsening) events (as death, lung transplantation, hospitalization due to PH, new PAH-targeted medication), than patients of the control group (15 vs. 25 events, p < 0.05). These differences also led to lower estimated health-care costs of 657 € (14,359 training group vs. 14,973 € control group) within a period of two years.

Conclusion: This is the first study investigating the cost-effectiveness of exercise training in pulmonary hypertension. Within 2 years, health-care costs were lower in patients performing exercise training as add-on to medical therapy, than in patients with medical treatment only, due to less cost associated with worsening events. Further prospective studies are needed to confirm these findings.