The authors investigated whether an out-patient rehabilitation program followed by long-term home exercise training is an efficient approach to managing chronic disease, both in terms of therapeutic result and overall cost. Eighty patients (24 with chronic heart failure, 34 with chronic obstructive pulmonary disease, and 22 with type 2 diabetes) participated in this study, which was a parallel-group, randomized trial. Patients were assigned either to the outpatient rehabilitation program followed by long-term home exercise training (intervention group (IG)) or to usual care (control group (C)). The results showed that walking distance increased significantly in IG while it decreased in C, dyspnea at the end of the 6-minute walking test decreased in IG while it increased in C, Voorips score was higher in IG compared with C, the medical cost (including hospitalization, visits to the practitioner, and therapy) was not significantly different at day 120 or day 240 between the two groups but it was significantly lower at day 365 in IG compared with C (Euro 1,488 +/- 2,183 versus Euro 2,957 +/- 2,946; p < 0.03), and the total cost (medical cost plus the rehabilitation program cost) was lower in IG compared with C at day 365 (Euro 2,879 +/- 2,847 versus Euro 4,786 +/- 3,237; p < 0.08). The authors conclude that their outpatient rehabilitation program is cost-effective for the management of chronic disease.

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