OBJECTIVE: To assess the cost-effectiveness of a cardiac rehabilitation (CR) program specifically designed for cardiac patients with obesity versus standard CR. DESIGN: Cost-effectiveness analysis based on observations in a randomized controlled clinical trial. SETTING: Three regional CR centres in the Netherlands. PARTICIPANTS: Cardiac patients (n = 201) with obesity (BMI >= 30 kg/m2) referred to CR. INTERVENTIONS: Participants were randomised to a CR program specifically designed for patients with obesity (OPTICARE XL; n = 102) or standard CR. OPTICARE XL included aerobic and strength exercise and behavioural coaching on diet and physical activity during 12 weeks, followed by a 9 month after-care program with 'booster' educational sessions. Standard CR consisted of a 6 to 12-week aerobic exercise program, supplemented with cardiovascular lifestyle education. MAIN OUTCOME MEASURES: An economic evaluation, with an 18-month time horizon, in terms of quality-adjusted life years (QALYs) and costs from the societal perspective was performed. Costs were reported in 2020 Euros, discounted at a 4% annual rate, and health effects were discounted at a 1.5% annual rate. RESULTS: OPTICARE XL CR and standard CR resulted in comparable health gain per patient (0.958 versus 0.965 QALYs, respectively; p = 0.96). Overall, OPTICARE XL CR saved costs (-4,542 Euro) compared to the standard CR group. The direct costs for OPTICARE XL CR were higher than for standard CR (10,712 Euro versus 9,951 Euro), whereas indirect costs were lower (51,789 Euro versus 57,092 Euro), but these differences were not significant. CONCLUSIONS: This economic evaluation showed no differences between OPTICARE XL CR and standard CR in health effects and costs in cardiac patients with obesity.

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