背景與目的：針對各種醫療計畫進行療效評估及成本分析，是使有限的醫療資源做最有效運用的方法之一。本研究的目的在探討冠狀動脈繞道手術病患接受門診運動訓練的成本效用，希望能夠作為將來國內心臟復健相關研究之參考。方法：本研究利用病歷回溯及自行設計之問卷，調查於民國88年11月至90年10月間，接受門診運動訓練之運動組與以年齡、性別及血管阻塞情形配對、且距開刀時間相似之對照組病患在訓練後6個月內之相關醫療照護成本；再利用先前研究之生活品質調整存活時間的差異，進行成本效用分析。本研究於三家醫院徵得運動訓練組45位、對照組41位，共86位病患之同意，完成問卷調查。結果：兩組病患之基本資料及病史僅於個人收入方面有差異，運動組收入高者居多(p<0.05)。追蹤6個月之結果發現平均每位運動組病患若接受8週之門診運動訓練所需之成本為31,106元，之後6個月內每位對照組病患之住院費用較運動組高出10,542元，故運動組病患所需增加之整體醫療成本為20,564元。由先前研究結果得知運動組病患增加的環境範疇品質調整存活時間為0.069年，因此運動訓練獲得改善的環境範疇之成本效用值為298,029元／品質調整存活年。結論：運動訓練對冠狀動脈繞道手術病患而言，是一種符合經濟考量的療法。

Background and Purpose: A major challenge for all health care systems is to identify the most efficient use of finite resourses available for health care. Economic evaluation is one strategy to assist decision-makers to make rational choices among alternative health care services. The purpose of this study was to examine the cost-utility of outpatient exercise training versus usual care for patients following coronary artery bypass grafting (CABG). Methods: First-time CABG patients from three medical centers were recruited and evaluated throughout Nov 1999 to Oct 2001. Forty-five patients who participated in supervised outpatient exercise training programs and 41 age-, gender-, and severity-matched controls with similar duration since surgery served as subjects of the study. A self-designed questionnaire was developed to estimate the direct and indirect costs in the following six months of all the subjects. Their medical history and hospitalization related data in the six months were collected and confirmed by chart review. The quality adjusted life year (QALY) data of our previous study was used to calculate the cost-utility. Chi-square and independent t-test were used to make group comparisons. Results: The basic data were similar in subjects of two groups except more persons in the exercise group had higher incomes. The estimated cost of eight-week exercise training was NT 31,106, while the extra expenses from hospitalization in control group was NT 10,542 per patient. Thus the incremental cost of exercise training was NT 20,564 per patient. Our previous study revealed QALY gained from exercise training were 0.06 9 year for environment domain therefore the cost utility ratio was NT 298,029.0/QALY. Conclusion: Our results indicate that outpatient exercise training after CABG is an effective therapeutic intervention from the viewpoint of cost-utility.