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Cost-effectiveness of a dedicated cardio-oncology rehabilitation service

Comment by Vass Vassiliou, member of the Population Science and Public Health Section

Cardio-Oncology
Risk Factors and Prevention


Cancer is becoming increasingly prevalent in our society, with projections indicating that by 2040, up to 30 million new cases will be diagnosed annually. Following multiple advances in cancer treatment over the past few decades, this has led to significantly improved outcomes, allowing many cancer survivors to live longer. However, this comes at an elevated risk of cardiovascular disease, which arises from the malignancy itself, the direct effects of cancer therapies and the accumulation of risk factors with ageing. Consequently, managing this heightened risk has become a priority in the care of cancer survivors.

We therefore welcome novel and specific cardiac rehabilitation programmes, bespoke and dedicated to cancer survivors. The clinical results of these initiatives have already been published (1,2) and are beneficial for patients. However, what is not known is whether such programmes are cost-effective, as the increased support provided in these clinics comes at an increased cost.

A cost-effectiveness analysis has recently been published in the European Journal of Preventive Cardiology (EJPC) to address specifically this point. More explicitly, does a slight increase in early cost lead to a cost-effective end result for a dedicated cardiac rehabilitation programme in cardiac oncology (3)? The authors conducted a dedicated randomized clinical trial (RCT), allocating cancer survivors to the usual rehabilitation programme seen in general rehabilitation clinics or the bespoke programme specific for cancer survivors. The RCT showed that there was an improvement in VO2 max, systolic and diastolic blood pressures, and these benefits were accompanied by better literacy scores and most importantly increased adherence to the programme. Very reassuring, this paper in EJPC (3) demonstrated that the cost per QALY was only €1,383 (much lower than the cut-off usually accepted by health organisations in many countries ranging between €5,000- €30,000), suggesting that such specific programmes can be cost-effective.

Whilst some limitations of the study should be considered (e.g., the small number of participants, the single centre design and the short duration of follow up - only 8 weeks), these results remain optimistic and support the underlying hypothesis that these programs may be quite beneficial.

There is no doubt that with improvements in oncology care and longer survival for patients we should become more proactive in protecting the myocardium and preventing myocardial dysfunction, rather than simply and rather lately reacting to impairment in systolic function. In the absence of prognostic medications to prevent this, dedicated rehabilitation programmes would be a desirable and cost-effective way to support our oncology patients. What this study adds is that the patients also prefer it, adhere more to it and it is cost-effective. The real question remains, however, whether health organisations and rehabilitations centres have the capacity to create such bespoke programmes in the near future.  

References

Vass Vassiliou commented on:

3. Viamonte SG, Tavares A, Alves AJ et al. Cost-effectiveness analysis of a cardio-oncology rehabilitation framework compared to an exercise intervention for cancer survivors with high cardiovascular risk. European Journal of Preventive Cardiology 2024:zwae181.

Additional references:

1. Gilchrist SC, Barac A, Ades PA et al. Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors: A Scientific Statement From the American Heart Association. Circulation 2019;139, DOI: 10.1161/CIR.0000000000000679.

2. Viamonte SG, Joaquim AV, Alves AJ et al. Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk: A Randomized Clinical Trial. JAMA Cardiol 2023;8:1119.

Notes to editor

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.