(P167) REAL-WORLD OUTCOMES & HEALTH CARE COSTS OF REGION-WIDE COMMUNITY-BASED CARDIAC REHABILITATION

Background: Community-based cardiac rehabilitation (CR) programs may offer a more pragmatic alternative to conventional centre-based CR. Since 2000 the Central East health region of Ontario has offered a publicly funded, centrally coordinated, community-based CR program. This type of region-wide CR coordination and programming is novel. We evaluated the efficacy and public-payer health care costs among patients who entered the program following coronary artery bypass surgery, coronary artery stenting or myocardial infarction between 2012 and 2015.

METHODS AND RESULTS: Using propensity score methods, we matched 2,525 CR participants on a 1:1 basis to individuals who experienced a cardiac event and resided in other regions of Ontario where region-wide community-based CR programs were not available. In efficacy analysis, participants were followed for 3 years for a subsequent cardiac event or cardiovascular death and compared using sub-distribution hazards models. In costing analysis, public-payer health care costs (including CR program costs) were compared between groups using a generalized estimating equation with a log link. In secondary analysis, matched sets were restricted to CR completers (1,766 matches) and efficacy and costing analyses were repeated with a 2-year follow-up. No appreciable differences in the primary efficacy analysis (3-year follow-up for subsequent cardiac events or death, n=2,525 matched pairs) were observed between CR participants and non-participants (Hazard Ratio [HR]: 0.9, 95% CI: 0.0.77-1.05). Compared to CR participants, the non-participants experienced a 31% increase in healthcare costs ($5,868 per patient) over the 3-year period following CR initiation (incidence rate ratio [IRR]: 1.31, 95% CI: 1.18-1.46). In the secondary analysis (2-year follow-up, n=1,766 matched pairs), CR program completers experienced a 27% lower risk of cardiac events or death compared to non-participants (HR: 0.73, 95% CI: 0.58-0.91), while non-participants experienced a 42% increase in healthcare costs ($4,860 per patient) over the 2-year period following CR completion (IRR: 1.42, 95% CI: 1.25-1.61) compared to CR participants.

Conclusion: Region-wide community-based CR services may offer public-payer cost savings with improved cardiac outcomes among individuals who complete the program.