Cost-Effectiveness of a Prehabilitation Program in Patients Listed for Heart Transplantation.

Patients on the waiting list for Heart Transplantation (HT) benefit from prehabilitation programs to improve their physical condition prior to HT. However, the implementation of a prehabilitation program in advanced heart failure patients is health resource consuming and could represent an economical burden for HT centres. The aim of this study is to evaluate the cost-effectiveness of an ambulatory multimodal prehabilitation program for HT candidates. We performed a cost analysis of a prehabilitation program consisting of supervised exercise training, nutritional optimization and psychological support in patients undergoing elective HT in a single centre from 2017 to 2021. Healthcare use included cost of the prehab program and cost of the index hospitalization for HT measured by micro-costing techniques and hospital specific fees. Costs of the program included gym facilities, physiotherapist and nutritionist fees, protein supplementation and psychology fees. We compared total cost of patients attending the prehabilitation program (n=31) with a group of patients who did not join the program or were transplanted before the implementation of the program (n=51). To control for the skewness of the distribution a bootstrapping approach was performed. Mean cost of the prehabilitation program per patient was 2,195±1,336 €. Total mean cost per patient was lower in the prehab-group than in the control-group (56,503±24,169 vs. 66,556±33,593 €, p =0.12). The bootstrapping showed a difference in costs favouring the prehab-group of 2,248€ (95% CI: -10,952-15,010; p =0.37), although both differences were statistically non-significant. Main savings were driven by shorter ICU stay (5 vs. 7 d, p =0.01) and total LOS (18 vs. 23 d, p =0.008) and a reduction in pharmacy and blood costs. A multimodal prehabilitation program in patients awaiting HT could improve clinical outcomes without increasing costs. The cost of the program would be compensated by less postoperative complications. [ABSTRACT FROM AUTHOR]