To determine the components and the costs of an exercised-based rehabilitation program for patients with chronic systolic HF, from the point of view of the provider of the service. Systematic review of the literature and expert consensus. Identification of components of HF rehabilitation programs, based on the literature, and Delphi rounds of experts for consensus. Only variable costs associated with the components of the program were estimated, based on the Colombian 256 agreement of 2001 (the Colombian norm that set the tariff for reimbursement for health care services) plus 23%, 30%, or 48%, to approximate the range of costs in current (2012) health care package negotiations in Colombia between providers and payers. For 2012, US$1=COL$1,783. Based on expert consensus of cardiologists and physical therapists, 18 components of the rehabilitation program were identified. After the second round, over 80% agreement was obtained for the remaining three components, and an additional component was identified. After the third round, consensus was obtained for a program of 36 rehabilitation sessions and 19 components. With the base-case scenario of agreement 256 plus 30%, the cost per session of the program was inversely proportional to the number of patients in each session: COL $96,903 for one patient, and COL $11,623 for 15 patients. For a program with 10 patients per session, the costs of a program may range from COL$ 471,130 to COL $656,554, depending on the agreement type. Agreement is critical to unify criteria on the components of a rehabilitation program that is both effective and safe for patients with HF. From the point of view of the provider, variable costs associated with implementation are sensitive to the number of patients per session. This study should set the basis for the estimation of the cost-effectiveness of rehabilitation programs in heart failure.
Tópico:
Health Systems, Economic Evaluations, Quality of Life