Natalia Maldonado, Catherine Verdugo

Resumen

Objetivo: Determinar las razones de la subutilización del Ejercicio Supervisado (ES) en pacientes con claudicación intermitente. Fuentes de datos: PubMed y ScienceDirect.

Método: Se incluyeron las Revisiones con acceso completo, publicados desde el año 2013, que incluían como mínimo 3 artículos de tipo cuantitativo.

Resultados: Sobre los efectos del ejercicio supervisado, a largo plazo (>12meses) tiene mejores resultados en la distancia máxima caminada (120-210 mts más), pero no en la calidad de vida. En la costo-efectividad el ES vs Ejercicio no supervisado fue más rentable,con un ratio de costo-efectividad de £ 711 a £ 1.608 en calidad de vida por año ganado. Sobre la baja derivación, en Europa un 30,4% tuvo acceso a ES.

Conclusión: La principal dificultad para adoptar el ES no es una falta de evidencia, sino una carencia en la destinación de recursos y falta de conocimiento de los efectos de esta terapia.

Palabras claves: health care costs, intermittent claudication, rehabilitation

Systematic review: Cost-effectiveness, access and adherence to supervised exercise programs in patients with intermittent claudication

Abstract

Objective: To determine the reasons for the limited derivation, access and adherence to supervised exercise programs (SEP) in patients with intermittent claudication (IC) and the cost-effectiveness of these programs internationally.

Methods: PubMed and ScienceDirect databases were searched. Revisions with full access, published since 2010, which included at least 3 quantitative type articles.

Results: 5 reviews were included, these were associated with the results of the supervised exercise, its cost-effectiveness, the low referral and adherence to programs of patients with IC. Regarding cost-effectiveness, the results indicated that SEP were more cost-effective with an ICER of £711 to £1.608 per QALY gained when compared with unsupervised exercise, and that when compared with revascularization surgery (RC) there was no significant difference in QALYs, however the cost per QALY was € 381.694 higher for the RC. On the other hand, the main reasons for the underutilization of SEP are that patients are reluctant to attend, since it involves effort and responsibility, in addition to having reimbursement problems, therefore having low adherence. Added to this, the personal interest of doctors in performing interventions that involve payment for service produce a low referral (45% of surgeons in Europe refer less than 50% of their patients)

Conclusion: The main difficulties in adopting the SEP would be a lack in the allocation of resources, lack of centers, difficulty of transportation, lack of time or lack of interest from patients, in addition to financial incentives to other treatment alternatives over SEP, which limits their referral.

Keywords: Cost Effectiveness, Intermittent Claudication (Mesh), Underused, Adherence (Mesh), Supervised Exercise.