HF-ACTION: Cost incurred for exercise and usual care in HF patients similar

Patients with symptomatic HF randomly assigned to exercise training exhibited no cost benefit nor a decreased hospitalization rate vs. patients randomly assigned to usual care, results from the HF-ACTION study suggested.

The researchers assigned 2,331 outpatients with medically stable HF to either an exercise training or usual care group. They collected extensive data on medical resource use and hospital bills for estimates of direct medical costs.

During the mean follow-up of 2.5 years, there were 2,297 hospitalizations in the exercise group and 2,332 in the usual care group. The mean number of inpatient days was 13.6 (standard deviation, 27 days) in the exercise group and 15 (standard deviation, 31.4 days) in the usual care group. Other measures of resource use were similar between groups, including ED and urgent care visits, except for trends that suggested that fewer patients in the exercise group underwent high-cost inpatient procedures.

Estimated total direct medical cost per participant was $50,857 (standard deviation, $81,488) in the exercise group and $56,177 (standard deviation, $92,749) in the usual care group. The direct cost of exercise training was an estimated $1,006 (standard deviation, $337), whereas patient time costs, including supervised training and home exercise time, were an estimated $5,018 (standard deviation, $4,600).

According to the researchers, “Relative to the overall cost of HF to the health care system, costs associated with exercise training are small. However, in this economic evaluation, we found little systematic benefit in terms of overall medical resource use with this intervention.”

Read more of CARDIOLOGY TODAY's coverage of the HF-ACTION study here.– by Brian Ellis

Reed S.Circ Cardiovasc Qual Outcomes. 2010;doi:10.1161/CIRCOUTCOMES.109.907287.

First, the direct cost of the exercise program was not very high. The authors then used an indirect assessment of patient time spent as an added cost. I am not sure this is widely applicable to the HF population. They hint at this in the manuscript. The conclusion that the cost/benefit ratio is not in favor of an exercise program is in my view an overstatement. The main concern I have is that CMS and other payers may continue to not support rehab efforts in HF based on this sub-selection of patients with costs increased based on assessed cost of patient time.

– Frank Smart, MD

Cardiology Today Editorial Board

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