Cardiac rehabilitation in low- and middle-income countries: a review on cost and cost-effectiveness.

Background: By 2030, more than 80% of cardiovascular disease-related deaths and disability-adjusted life years will occur in the 139 low- and middle-income (LMIC) countries. Cardiac rehabilitation (CR) has been demonstrated to be effective and cost-effective mainly based on data from high-income countries. The purpose of this paper was to review the literature for cost and cost-effectiveness data on CR in LMICs. Methods: MEDLINE (Ovid) and EMBASE (Ovid) electronic databases were searched for CR 'cost' and 'costeffectiveness' data in LMICs. Results: Five CR publications with cost and cost-effectiveness data from middle-income countries were identified with none fromlow-income countries. Studies from Brazil demonstrated mean monthly savings of US$190 for CR, with a US$48 increase in a control group with mean costs of US$503 for a 3-month CR program. Mean costs to the public health care system of US$360 and US$540 when paid out-of-pocket were reported for a 3-month CR program in seven Latin American middle-income countries. Cardiac rehabilitation is reported to be cost-effective in both Brazil and Colombia. Conclusions: Cardiac rehabilitation for patients with heart failure in Brazil and Colombiawas estimated to be costeffective. However, given the limited health care budgets in many LMICs, affordable CR models will need to be developed for LMICs, particularly for low-income countries. [ABSTRACT FROM AUTHOR]