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1 (p< 0.05) 6 8 3,06 6 0,54 0, ,09 ( 005:30():-0) (cardiac rehabilitation) 3-5 Relman Levin (0) ytw@ccms.ntu.edu.tw

2 % 5.3% () () (3) 4 ( % 50-75% 44 ) () ( ) (3) (4) 45 4 (5) 86 () () (3) (4) (5) ( ) (6) () ( ) (society viewpoint) 3

3 90 ( % 0.96%) (cost-utility analysis) (45-74 ). ( ) 0 7 (multidimensional) 0,000 40, ,000 (health-related quality of life) (p< 0.05) (health prolife) (utility) ( 4-4 ) (quality-adjusted life years, QALY). ( ) (n 45) (n=4) p ( ) ( ) ( ) ( 65 ) (.) (9.3) MC-QAS (Monte Carlo-quality 8 (40.0) 7 (4.4) adjusted survival) 3 7 (48.9) (9.3) * 9,999 7 (5.6) 6 (39.0) 0,000-39,999 5 (33.3) 7 (4.5) 40,000 3 (5.) 8 (9.5) C C QALY QALY C 0.9 QALY (4.5) (4.9) 0 6 (3.3) 8 (9.5) SPSS 0.0 (SPSS for 3 6 (57.8) (53.7) windows release 0.0,SPSS Inc.,Chicago,USA) 3 6 (3.3) 6 (4.6) 5 (.) 3 (7.3) t 0.88 (t-test) 7 (4.5) 3 (5.) (chi-square test) 0 (44.4) 7 (4.5) p< (40.0) (53.7) 6 (3.3) 5 (.) * ( ) 4

4 ( ) , , , ( ) 4,750 47,500 ( / ) (n 4) (n 45) (p 0.8) (p< 0.05) 7 89 a * 3, , (p 0.59) , (8.%) (6.%) a *p< 0.05 (n 4) ( )( 90 ) ( / ) / / * * n=

5 9 7 Shaw (995 ) , , ,06 6 0,54 6 0,564 (3,06 0,54 ) ,09 6 0,54 99 Levin Levin (0.7 vs. 6. ) 8,570 Bondestam (p< 0.05) 9 Ades 99 (retrospective) ( -46 ) (58%) (4%) , % (analysis of covariance) (p 0.007) 6 (YMCA) 5 4 Ades 99 Oldridge Oldridge 993 ( 8 ) 50 (99 ) 6 6

6 65 6,653.7 (3,06 8,45.3 ) 65 83,387 ( ) (sensitivity analysis) Engblom Levin 3,06 5 0,54 (5.8% vs 7.4% p< 0.0) 6 6 3,56 (4 0 ) ( 30 ) 5,0 36,7 Oldridge (99 ) 6 Oldridge (99 ) (trajectory), ,54 5,30 6 5,804 (3,06 5,30 ) 9, , (highly cost-effective) ,8 9.% 7 9 3, % 48% 98,09 ( 4% (996 4.) ) (relatively cost-effective),

7 4. Hatziandreu Levin 99,33 QALY 67 QALY ,000 ( ) Ades 99 36, Oldridge ,00 QALY 0 0, ,09 QALY QALY Kinetics;999. p Dafoe W, Patricia H. Current trends in cardiac rehabilitation. Can Med Assoc J 997;56: Gohlke H, Gohlke-Barwolf C. Cardiac rehabilitation. Eur Heart J 998;9: Hall LK. Will my cardiac rehabilitation program survive in the new managed-care era? The road map will be drawn by measuring outcomes. J Cardiopulm Rehabil 998;8:9-6..Relman AS. Assessment and accountability-the third revolution in medical care. N Engl J Med 988;3:0-. 3.American Association of Cardiovascular & Pulmonary Rehabilitation. Guideline for Cardiac Rehabilitation and Secondary Prevention Programs.3rd ed. Champaign, IL: Human 6.Levin LÅ, Perk J, Hedbäck B. Cardiac rehabilitation-a cost analysis. J Intern Med 99;30: Kupersmith J, Holmes-Rovner M, Hogan A, Rovner D, Gardiner J. Cost-effectiveness analysis in heart disease, part I: general 8

8 principles. Prog Cardiovasc Dis 994;37: after acute myocardial infarction 65 years of age. Am J 00 Cardiol 995;75: MC-QAS 4.Shephard RJ. Exercise in secondary and tertiary rehabilitation: costs and benefits. J Cardiopulm Rehabil 989;9: Ades PA, Pashkow FJ, Nestor JR. Cost-effectiveness of cardiac rehabilitation after myocardial infarction. J Cardiopulm Rehabil 997;7:-3. 6.Oldridge NB, Furlong W, Feeny D, Torrance G, Guyatt G, Crowe J, et al. Economic evaluation of cardiac rehabilitation soon after acute myocardial infarction. Am J Cardiol 993;7: Shaw DK, Sparks KE, Jennings HS, Vantrease JC. Cardiac rehabilitation using simultaneous voice and electrocardiographic transtelephonic monitoring. Am J Cardiol 995;76: Bondesatm E, Breikks A, Hartford M. Effect of early rehabilitation on consumption of medical care during the first year 0.Ades PA, Huang D, Weaver SO. Cardiac rehabilitation participation predicts lower rehospitalization costs. Am Heart J 99; 3:96-..Engblom E, Korpilahti K, Hamalainen H, RonnemanT, Puukks P. Quality of life and return to work 5 years after coronary artery bypass surgery. J Cardiopulm Rehabil 997;7: Goldman L, Garber AM, Grover SA, Hlatky MA. Cost effectiveness of assessment and management of risk factors. J Am Coll Cardiol 996;7: Daumer R, Miller P. Effects of cardiac rehabilitation on psychosocial functioning and life satisfaction of coronary artery disease clients. Rehabil Nurs 99;0:

9 Cost-Utility Analysis of Outpatient Exercise Training after Coronary Artery Bypass Grafting Su-Ying Hung Chen-Liang Chou Jau-Yih Tsauo Ming-Chin Yang 3 Shoei-Shen Wang 4 Ying-Tai Wu Background and Purpose: A major challenge for all health care systems is to identify the most efficient use of finite resourses available for health care. Economic evaluation is one strategy to assist decision-makers to make rational choices among alternative health care services. The purpose of this study was to examine the cost-utility of outpatient exercise training versus usual care for patients following coronary artery bypass grafting (CABG). Methods: First-time CABG patients from three medical centers were recruited and evaluated throughout Nov 999 to Oct 00. Forty-five patients who participated in supervised outpatient exercise training programs and 4 age-, gender-, and severity-matched controls with similar duration since surgery served as subjects of the study. A self-designed questionnaire was developed to estimate the direct and indirect costs in the following six months of all the subjects. Their medical history and hospitalization related data in the six months were collected and confirmed by chart review. The quality adjusted life year (QALY) data of our previous study was used to calculate the cost-utility. Chi-square and independent t-test were used to make group comparisons. Results: The basic data were similar in subjects of two groups except more persons in the exercise group had higher incomes. The estimated cost of eight-week exercise training was NT 3,06, while the extra expenses from hospitalization in control group was NT 0,54 per patient. Thus the incremental cost of exercise training was NT 0,564 per patient. Our previous study revealed QALY gained from exercise training were year for environment domain, therefore the cost utility ratio was NT 98,09.0/QALY. Conclusion: Our results indicate that outpatient exercise training after CABG is an effective therapeutic intervention from the viewpoint of cost-utility. (FJPT 005;30():-0) Key Words: CABG, Outpatient exercise training, Cost-utility School of Physical Therapy, College of Medicine, National Taiwan University Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital 3 Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University 4 Department of Surgery, National Taiwan University Hospital Correspondence to: Ying-Tai Wu, School of Physical Therapy, College of Medicine, National Taiwan University, No., Section, Jen Ai Road, Taipei 00, Taiwan. Tel: (0) ytw@ccns.ntu.edu.tw Received: Jul, 004 Accepted: Sep 7, 004 0