The Economic Evaluation of a Symptom Management Intervention on Physical Activity in the Older Patients Following Coronary Artery Bypass Surgery.

BACKGROUND: Coronary artery bypass surgery (CABS), a costly cardiac procedure, is commonly performed in the older population. Women have higher costs of index hospitalization related to CABS, and inferior outcomes compared to men. A symptom management (SM) intervention has been reported effective to improve women's physical activity at three months following CABS.PURPOSE: 1) To determine the effects of gender and the SM intervention on the costs of healthcare utilization (HCU) related to post CABS care in the first 3 months after surgery (Manuscript 1); 2) To determine the efficiency (cost-effectiveness) of the SM intervention on physical activity variables (daily energy expenditure, minutes spent on moderate-to-vigorous activity per day) in women at three months following CABS (Manuscript 2).METHODS: This secondary analysis uses existing data from a previous 2-group, repeated measure, randomized control trial (RCT). Descriptive statistics are used to depict the sample, cost and physical activity data. Non-parametric tests were used to compare group differences in cost and physical activity variables. The log-link generalized linear model with negative binomial variance function was used to determine the effects of gender and SM intervention on physical activity outcomes. Finally, the cost-effectiveness analysis (CEA) is conducted to determine the efficiency of SM intervention on physical activity in women at 3 months after CABS.RESULTS: During the first three months after CABS, the intervention had no effect on the HCU costs related to post CABS care. However, women had higher HCU costs than men. The CEA suggests the SM intervention could be potentially efficient (cost effective) to improve the physical activity in women at three months CABS.CONCLUSIONS: Women have higher HCU costs of post CABS care than men in both outpatient and hospital settings in the first 3 months after surgery. Future RCT with large cohort of women is needed to draw reliable conclusion of the efficiency of SM intervention to improve physical activity and reduce the HCU costs of post-CABS care in women during the early stage of recovery following CABS.