Out-of-pocket spending for cardiac rehabilitation and adherence among US adults.

Objectives: Although cardiac rehabilitation (CR) improves cardiovascular outcomes, adherence remains low. Higher patient-incurred out-of-pocket (OOP) spending may be a barrier to CR adherence. We evaluated the association between OOP spending for the first CR session and adherence.

Study design: Retrospective analysis.

Methods: Commercial and Medicare supplemental beneficiaries with a CR-qualifying event between 2016 and 2020 who attended at least 1 CR session within 6 months of discharge were identified in the MarketScan Commercial Database. OOP spending for the first session was categorized as zero or into 1 of 3 increasing tertiles of OOP spending. Poisson regression was used to determine the association between OOP-spending tertile and CR adherence, defined as the number of CR sessions attended within 6 months of discharge.

Results: A total of 43,992 beneficiaries attended at least 1 CR session. Of these, 35,883 (81.6%) paid $0, 2702 (6.1%) paid $0.01 to $25.39, 2704 (6.1%) paid $25.40 to $82.41, and 2703 (6.1%) paid at least $82.42 for the first session, constituting the first, second, and third OOP-spending tertiles, respectively. Compared with the zero-OOP cohort, the first-tertile cohort attended 13.5% (95% CI, 1.4%-27.1%; P  = .028) more CR sessions and the second- and third-tertile cohorts attended 11.9% (95% CI, -16.4% to -7.1%; P  < .001) and 30.9% (95% CI, -40.8% to -19.4%; P  < .001) fewer CR sessions on average, respectively. For every additional $10 spent OOP on the first CR session, patients attended 0.41 fewer sessions on average (95% CI, -0.65 to -0.17; P  < .001).

Conclusion: Among patients with OOP spending, higher spending was associated with lower CR adherence, dose dependently. Reducing OOP costs for CR may improve adherence for beneficiaries with cost sharing.