Cost-effectiveness of High-Intensity Interval Training (HIIT) vs Moderate Intensity Steady-State (MISS) Training in UK Cardiac Rehabilitation

Albustami, Mohammed; Hartfiel, Ned; Charles, Joanna M; Powell, Richard; Begg, Brian; Birkett, Stefan T; Nichols, Simon; Ennis, Stuart; Hee, Siew Wan; Banerjee, Prithwish; Ingle, Lee; Shave, Rob; Mcgregor, Gordon; Edwards, Rhiannon T

Abstract

Objective: To perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared with moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR). Design: Secondary cost-effectiveness analysis of a prospective, assessor-blind, parallel group, multi-center RCT. Setting: Six outpatient National Health Service cardiac rehabilitation centers in England and Wales, UK. Participants: 382 participants with CAD (N=382). Interventions: Participants were randomized to twice-weekly usual care (n=195) or HIIT (n=187) for 8 weeks. Usual care was moderate intensity continuous exercise (60%-80% maximum capacity, MISS), while HIIT consisted of 10 £ 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery. Main Outcome Measures: We conducted a cost-effectiveness analysis of the HIIT or MISS UK trial. Health related quality of life was measured with the EQ-5D-5L to estimate quality-adjusted life years (QALYs). Costs were estimated with health service resource use and intervention delivery costs. Cost-utility analysis measured the incremental cost-effectiveness ratio (ICER). Bootstrapping assessed the probability of HIIT being cost-effective according to the UK National Institute for Health and Care Excellence (NICE) threshold value (£20,000 per QALY). Missing data were imputed. Uncertainty was estimated using probabilistic sensitivity analysis. Assumptions were tested using univariate/1-way sensitivity analysis.

Citation

Albustami, M., Hartfiel, N., Charles, J. M., Powell, R., Begg, B., Birkett, S. T., Nichols, S., Ennis, S., Hee, S. W., Banerjee, P., Ingle, L., Shave, R., Mcgregor, G., & Edwards, R. T. (2024). Cost-effectiveness of High-Intensity Interval Training (HIIT) vs Moderate Intensity Steady-State (MISS) Training in UK Cardiac Rehabilitation. Archives of Physical Medicine and Rehabilitation, 105(4), 639-646. https://doi.org/10.1016/j.apmr.2023.09.005

• Journal Article Type: Article
• Acceptance Date: Sep 5, 2023
• Online Publication Date: Sep 18, 2024
• Publication Date: 2024-04
• Deposit Date: Oct 28, 2024
• Publicly Available Date: Oct 28, 2024
• Print ISSN: 0003-9993
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 105
• Issue: 4
• Pages: 639-646
• DOI: https://doi.org/10.1016/j.apmr.2023.09.005
• Keywords: Coronary artery disease, Exercise training, Health economics, Health utility, National Health Service, Rehabilitation
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0003999323005294