Quality Improvement and Quality Indicator-Related Interventions in Cardiac Rehabilitation: A Systematic Review of Economic Evidence Studies

BACKGROUND: Cost-effectiveness evidence on quality improvement (QI) and quality indicator-related interventions in cardiac rehabilitation is crucial for informing scalability; however, the evidence has not been systematically synthesised. We aimed to identify value measures, including costs, health outcomes and efficiency, assess reporting/methodological quality, and evaluate economic impacts of cardiac rehabilitation quality indicator-related interventions.

METHOD: Eight electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, NHS Economic Evaluation Database, Health Technology Assessments Database, Scopus, EconLit) were searched to retrieve studies published January 2000-July 2025 (7,639 studies identified, 4,573 screened after removing duplicates). Full and partial economic evaluations of QI and quality indicator-related interventions were included. Reporting quality of the full economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022.

RESULTS: Thirteen studies were identified, including eight full and five partial economic evaluations. Cost-effectiveness was demonstrated for QI-related interventions utilising shared-care models (incremental cost-effectiveness ratio: Danish krone 125,000/quality-adjusted life year), digital therapeutics (Chinese yuan 39,663.5/quality-adjusted life year), and internet-based case management (cost savings of United States dollar 738-965/patient). Interventions utilising learning and coping strategies were not cost-effective; however, there were cost-saving associated with the heart failure subgroup (Euro 12,399). Regarding quality, six of the full economic evaluations fulfilled >80% of the Consolidated Health Economic Evaluation Reporting Standards. Common gaps were lack of health economic analysis plans and subgroup analyses.

CONCLUSIONS: Evaluations should report on site-specific factors for QI achieved and use a standardised economic evaluation plan to guide additional QI implementation. To achieve this, greater investment is needed to better engage the diverse health leadership and jointly develop solutions integrating innovation and research.