***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Learning and coping education strategies ( LC ) was implemented to enhance patient attendance in the cardiac rehabilitation programme . This study assessed the cost-utility of LC compared to st and ard education ( st and ard ) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure . Methods The study was conducted alongside a r and omised controlled trial with 825 patients who were allocated to LC or st and ard rehabilitation and followed for 5 months . The LC approach was identical to the st and ard approach in terms of physical training and education , but with the addition of individual interviews and weekly team evaluations by professionals . A societal cost perspective including the cost of intervention , health care , informal time and productivity loss was applied . Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories . Quality adjusted life years ( QALY ) were based on SF-6D measurements at baseline , after intervention and follow-up using British preference weights . Multiple imputation was used to h and le non-response on the SF-6D . Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves . The statistical analysis was based on means and bootstrapped st and ard errors . Results An additional cost of DKK 6,043 ( 95 % CI −5,697 ; 17,783 ) and a QALY gain of 0.005 ( 95 % CI −0.001 ; 0.012 ) was estimated for LC . However , better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention . The probability that LC would be cost-effective did not exceed 29 % for any threshold values of willingness to pay per QALY . The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62 % over the threshold values . Discussion The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective , but longer-term follow-up should be evaluated before a definite conclusion is drawn . Conclusion Future research should assess the LC strategies ' long-term efficacy and cost-utility . Trial registration BACKGROUND Health-related quality of life ( HRQoL ) data in depression are limited . We studied the impact of antidepressant ( AD ) treatment on HRQoL outcomes in depressed patients and investigated factors associated with these outcomes in routine practice setting s. METHODS The Factors Influencing Depression Endpoints Research ( FINDER ) study was a 6-month , European , prospect i ve , observational study , design ed to estimate HRQoL in 3468 adult patients with a clinical ly diagnosed episode of depression at baseline and at 3 and 6-months after commencing AD treatment .  HRQoL was assessed by the Medical Outcome Short-Form ( 36 ) Health Survey ( SF-36 ) and European Quality of Life-5 Dimensions ( EQ-5D ) . Regression analysis identified baseline and treatment variables independently and significantly associated with HRQoL outcomes . RESULTS Most HRQoL improvement occurred within 3 months of starting treatment . Better HRQoL outcomes were strongly associated with fewer somatic symptoms at baseline , AD treatment taken and not switching within AD groups . Education and occupational status were also important . Depression variables ( number of previous depressions and current episode duration ) were consistently associated with worse HRQoL outcomes . Self-rated depression severity was associated with poorer outcomes on the SF-36 mental component only . LIMITATIONS As this was an observational study , the important finding that between and within AD group switching impacted HRQoL will need to be investigated in more controlled setting s. CONCLUSIONS Receiving an AD treatment was associated with large improvements in HRQoL , but switching within AD groups was consistently associated with poorer outcomes . Somatic symptoms , including painful symptoms , are often present in depressed patients and appear to negatively impact HRQoL outcomes Aim To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease ( IHD ) . Methods and results In this single-blind , parallel , two-arm , r and omized controlled trial adults ( n = 171 ) with IHD were r and omized to receive a mobile phone delivered intervention  ( HEART ; n = 85 ) plus usual care , or usual care alone ( n = 86 ) . Adult participants aged 18 years or more , with a diagnosis of IHD , were clinical ly stable as out patients , able to perform exercise , able to underst and and write English , and had access to the Internet . The HEART ( Heart Exercise And Remote Technologies ) intervention involved a personalized , automated package of text messages and a secure website with video messages aim ed at increasing exercise behaviour , delivered over 24 weeks . All participants were able to access usual community-based cardiac rehabilitation , which involves encouragement of physical activity and an offer to join a local cardiac support club . All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake ( PVO2 ; primary outcome ) , self-reported physical activity , health-related quality of life , self-efficacy and motivation ( secondary outcomes ) . Results showed no differences in PVO2 between the two groups ( difference −0.21 ml kg−1 min−1 , 95 % CI : −1.1 , 0.7 ; p = 0.65 ) at 24 weeks . However significant treatment effects were observed for selected secondary outcomes , including leisure time physical activity ( difference 110.2 min/week , 95 % CI : −0.8 , 221.3 ; p = 0.05 ) and walking ( difference 151.4 min/week , 95 % CI : 27.6 , 275.2 ; p = 0.02 ) . There were also significant improvements in self-efficacy to be active ( difference 6.2 % , 95 % CI : 0.2 , 12.2 ; p = 0.04 ) and the general health domain of the SF36 ( difference 2.1 , 95 % CI : 0.1 , 4.1 ; p = 0.03 ) at 24 weeks . The HEART programme was considered likely to be cost-effective for leisure time activity and walking . Conclusions A mobile phone intervention was not effective at increasing exercise capacity over and above usual care . The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services Background Few healthcare economic evaluations , and none in cardiac rehabilitation , report results based on both community and patient preferences for health outcomes . We published the results of a r and omized trial of  cardiac rehabilitation after myocardial infa rct ion in 1994 in which preferences were measured using both perspectives but only patient preferences were reported . This secondary analysis uses both types of preference measurements . Methods We collected  community Quality of Well-Being ( QWB ) and patient Time Trade-off ( TTO ) preference scores  from 188 patients ( rehabilitation , n = 93 ; usual care , n = 95 ) on entry into the trial , at 2 months ( end of the intervention ) and again at 4 , 8 , and 12 months . Mean preference scores over the 12-month follow-up study period , estimates of quality -adjusted life years ( QALYs ) gained per patient , incremental cost-effectiveness ratios [ costs inflated to 2006 US dollars ] and probabilities of the cost-effectiveness of rehabilitation for costs per QALY up to US$ 100 000 are reported . Results Mean QWB preference scores were lower ( P < 0.01 ) than the corresponding mean TTO preference scores at each assessment point . The 12-month changes in mean QWB and TTO preference scores were large and positive ( P < 0.001 ) with rehabilitation patients gaining a mean of 0.011 ( 95 % confidence interval , –0.030 to + 0.052 ) more QWB-derived QALYs , and 0.040 ( –0.026 , 0.107 ) more TTO-derived QALYs , per patient than usual care patients . The incremental cost-effectiveness ratio for QWB-derived QALYs was estimated at $ 60270/QALY ( about € 50 600/QALY ) and at $ 16580/QALY ( about € 13 900/QALY ) with TTO-derived QALYs . With a willingness to spend $ 100 000/QALY , the probability of rehabilitation being cost-effective is 0.58 for QWB-derived QALYs and 0.83 for TTO-derived QALYs . Conclusion This secondary analysis of data from a r and omized trial indicates that cardiac rehabilitation is cost-effective from a community perspective and highly cost-effective from the perspective of patients OBJECTIVE To estimate the incremental effects on cost and quality of life of  cardiac rehabilitation after an acute coronary syndrome . DESIGN Open r and omised controlled trial with 1 year 's follow-up . Analysis was on an intention-to-treat basis . SETTING Two tertiary hospitals in Sydney . INTERVENTION 18 sessions of comprehensive exercise-based outpatient cardiac rehabilitation or conventional care as provided by the treating doctor . PARTICIPANTS 113 patients aged 41 - 75 years who were self-caring and literate in English . Patients with uncompensated heart failure , uncontrolled arrhythmias , severe and symptomatic aortic stenosis or physical impairment were excluded . MAIN OUTCOME MEASURES Costs ( hospitalisations , medication use , outpatient visits , investigations , and personal expenses ) ; and measures of quality of life . Incremental cost per quality -adjusted life year ( QALY ) saved at 1 year ( this estimate combines within- study utility effects with reported 1-year risk of survival and treatment effects of rehabilitation on mortality ) . Sensitivity analyses around a base case estimate included alternative assumptions of no treatment effect on survival , 3 years of treatment effect on survival and variations in utility . RESULTS The estimated incremental cost per QALY saved for  rehabilitation  relative to st and ard care was 42,535 US dollars when modelling included the reported treatment effect on survival . This increased to 70,580 US dollars per QALY saved if treatment effect on survival was not included . The results were sensitive to variations in utility and ranged from 19,685 US dollars per QALY saved to rehabilitation not being cost-effective . CONCLUSIONS The effects on quality of life tend to reinforce treatment advantages on survival for patients having postdischarge rehabilitation after an acute coronary syndrome . The estimated base case incremental cost per QALY saved is consistent with those historically accepted by decision making authorities such as the Pharmaceutical Benefits Advisory Committee Abstract Background : Cardiac rehabilitation can reduce mortality of patients with cardiovascular disease , but a frequently low participation rate in rehabilitation programs has been found globally . The objective of the Teledialog study was to assess the cost-utility ( CU ) of a cardiac telerehabilitation ( CTR ) program . The aim of the intervention was to increase the patients ' participation  in the CTR program . At discharge , an individualized 3-month rehabilitation plan was formulated for each patient . At home , the patients measured their own blood pressure , pulse , weight , and steps taken for 3 months . Material s and Methods : The analysis was carried out together with a r and omized controlled trial with 151 patients during 2012–2014 . Costs of the intervention were estimated with a health sector perspective following international guidelines for CU . Quality of life was assessed using the 36-Item Short Form Health Survey . Results : The rehabilitation activities were approximately the same in the two groups , but the number of contacts with the physiotherapist was higher among the intervention group . The mean total cost per patient was € 1,700 higher in the intervention group . The quality -adjusted life-years ( QALYs ) gain was higher in the intervention group , but the difference was not statistically significant . The incremental CU ratio was more than € 400,000 per QALY gained . Conclusions : Even though the rehabilitation activities increased , the program does not appear to be cost-effective . The intervention itself was not costly ( less than € 500 ) , and increasing the number of patients may show reduced costs of the devices and make the CTR more cost-effective . Telerehabilitation can increase participation , but the intervention , in its current form , does not appear to be cost-effective OBJECTIVE To evaluate the long-term effect of a cardiac rehabilitation and prevention program ( CRPP ) on quality of life ( QOL ) and its cost effectiveness . DESIGN Prospect i ve , r and omized controlled trial . SETTING University-affiliated outpatient cardiac rehabilitation and prevention center . PARTICIPANTS A total of 269 patients ( 76 % men ; mean age , 64+/-11 y ) with recent acute myocardial infa rct ion ( AMI ; n=193 ) or after elective percutaneous coronary intervention ( PCI ; n=76 ) were r and omized in a ratio of 2 to 1 . INTERVENTION Patients received either CRPP ( an 8-wk exercise and education class in phase 2 ) or conventional therapy without exercise program ( control group ) . They were followed until they had completed all 4 phases of the program ( ie , 2 y ) . MAIN OUTCOME MEASURES QOL assessment s , by using the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and Symptoms Question naire , were performed at the end of each phase . Direct health care cost was calculated , whereas cost utility was estimated as money spent ( in US dollars ) per quality -adjust 
    Output:
    
Key drivers of cost-effectiveness were risk of subsequent events and hospitalisation , hospitalisation and intervention costs , and utilities .
Evidence suggests that CR is cost-effective , especially with exercise as a component .