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Cost-effectiveness of high-intensity interval training (HIIT) vs moderate intensity steady-state (MISS) training in UK cardiac rehabilitation.

Albustami, Mohammed; Hartfiel, Ned; Charles, Joanna M.; Powell, Richard; Begg, Brian; Birkett, Stefan T.; Nichols, Simon; Ennis, Stuart; Hee, Siew Wan; Banerjee, Prithwish; Ingle, Lee; Shave, Rob; McGregor, Gordon; Edwards, Rhiannon T.


Mohammed Albustami

Ned Hartfiel

Joanna M. Charles

Richard Powell

Brian Begg

Stefan T. Birkett

Stuart Ennis

Siew Wan Hee

Prithwish Banerjee

Lee Ingle

Rob Shave

Gordon McGregor

Rhiannon T. Edwards


The objective of this study was to perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared with moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR). The study utilised secondary cost-effectiveness analysis of a prospective, assessor-blind, parallel group, multi-center RCT, based in six outpatient National Health Service cardiac rehabilitation centers in England and Wales, UK. Participants (n=382) were randomized to twice-weekly usual care (n=195) or HIIT (n=187) for 8 weeks. Usual care was moderate intensity continuous exercise (60%-80% maximum capacity, MISS), while HIIT consisted of 10 × 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery. We conducted a cost-effectiveness analysis of the HIIT or MISS UK trial. Health related quality of life was measured with the EQ-5D-5L to estimate quality-adjusted life years (QALYs). Costs were estimated with health service resource use and intervention delivery costs. Cost-utility analysis measured the incremental cost-effectiveness ratio (ICER). Bootstrapping assessed the probability of HIIT being cost-effective according to the UK National Institute for Health and Care Excellence (NICE) threshold value (£20,000 per QALY). Missing data were imputed. Uncertainty was estimated using probabilistic sensitivity analysis. Assumptions were tested using univariate/1-way sensitivity analysis. 124 (HIIT, n=59; MISS, n=65) participants completed questionnaires at baseline, 8 weeks, and 12 months. Mean combined health care use and delivery cost was £676 per participant for HIIT, and £653 for MISS. QALY changes were 0.003 and -0.013, respectively. For complete cases, the ICER was £1448 per QALY for HIIT compared with MISS. At a willingness-to-pay threshold of £20,000 per QALY, the probability of HIIT being cost-effective was 96% (95% CI, 0.90 to 0.95). For people with CAD attending CR, HIIT was cost-effective compared with MISS. These findings are important to policy makers, commissioners, and service providers across the health care sector.


ALBUSTAMI, M., HARTFIEL, N., CHARLES, J.M., POWELL, R., BEGG, B., BIRKETT, S.T., NICHOLS, S., ENNIS, S., HEE, S.W., BANERJEE, P., INGLE, L., SHAVE, R., MCGREGOR, G. and EDWARDS, R.T. [2023]. Cost-effectiveness of high-intensity interval training (HIIT) vs moderate intensity steady-state (MISS) training in UK cardiac rehabilitation. Archives of physical medicine and rehabilitation [online], Articles In Press. Available from:

Journal Article Type Article
Acceptance Date Sep 5, 2023
Online Publication Date Sep 18, 2023
Deposit Date Nov 27, 2023
Publicly Available Date Nov 27, 2023
Journal Archives of physical medicine and rehabilitation
Print ISSN 0003-9993
Electronic ISSN 1532-821X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Keywords Coronary artery disease; Exercise training; Health economics; Health utility; National Health Service (NHS)
Public URL
Additional Information The supplementary materials for this article are included at the end of the file.