Cost-effectiveness of high-intensity interval training (HIIT) versus moderate intensity steady-state (MISS) training in UK cardiac rehabilitation

To perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared to moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR). Secondary cost-effectivness analysis of a prospective, assessor-blind, parallel group, multi-centre RCT. Six outpatient National Health Service cardiac rehabilitation centres in England and Wales, UK. 382 participants with CAD 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. We conducted a cost-effectiveness analysis of the HIIT or MISS UK trial. Health related qulity 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/one-way sensitivity analysis. 124 (HIIT, n=59; MISS, n=65) participants completed questionnaires at baseline, 8 weeks, and 12 months. Mean combined healthcare use and delivery cost was £676 per participant for HIIT, and £653 for MISS. QALY changes were 0.003 and -0.013, respectively. For complete cases, the ICER was £1,448 per QALY for HIIT compared to MISS. At a willingness-to-pay threshold of £20,000 per QALY, the probability of HIIT being cost-effective was 96% (95% CI, 0.90 to 0.95). For people with CAD attending CR, HIIT was cost-effective compared to MISS. These findings are important to policy makers, commissioners, and service providers across the healthcare sector. [Abstract copyright: Copyright © 2023. Published by Elsevier Inc.]