Cost-effectiveness of High-Intensity Interval Training (HIIT) vs Moderate Intensity Steady-State (MISS) Training in UK Cardiac Rehabilitation

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

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Objective: To perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared to moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR).

Design: Secondary cost-effectivness analysis of a prospective, assessor-blind, parallel group, multi-centre RCT.

Setting: Six outpatient National Health Service cardiac rehabilitation centres in England and Wales, UK.

Participants: 382 participants with CAD (N=382).

Interventions: Participants 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.

Main Outcome Measures: 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/one-way sensitivity analysis.

Results: 124 (HIIT, n=59; MISS, n=65) participants completed questionnaires at baseline, 8 weeks, and 12 months. Mean combined healthcare 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 £1,448 per QALY for HIIT compared to 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).

Conclusion: For people with CAD attending CR, HIIT was cost-effective compared to MISS. These findings are important to policy makers, commissioners, and service providers across the healthcare sector.

Original languageEnglish
Pages (from-to)(In-Press)
Number of pages8
JournalArchives of Physical Medicine and Rehabilitation
Early online date18 Sept 2023
Publication statusE-pub ahead of print - 18 Sept 2023

Bibliographical note

This is an open access article under the CC BY license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (


  • Coronary artery disease
  • Exercise training
  • Health economics
  • Health utility
  • National Health Service
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation


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