A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving

Abstract

Background Patients with cirrhosis and ascites experience frequent hospital admissions, leading to poor quality of life and high healthcare costs. Monitoring weight is a component of ascites care and telemonitoring may improve outcomes and costs. Goals We aimed to evaluate the cost and outcomes of current care compared to a telemonitoring system for ascites. Study We developed a decision-analytic model that examined 100 simulated patients over a 6-month horizon. We compared usual care to a new telemonitoring program, which we estimate costs $50,000/6 months. Results The cost of standard of care for 100 patients with cirrhotic ascites over a 6-month period is $167,500 more expensive than telemonitoring. By varying parameter probabilities by ± 10% and outcome costs by ± 20%, we found that standard of care remains more expensive than care with a telemonitoring intervention by $9400 to $340,200 per 6-month period. Standard of care leads to 9 more admissions (range 4 to 12) than a telemonitoring intervention, while telemonitoring leads to 9 more outpatient visits (range 6 to 9) and 28 additional outpatient large volume paracenteses (LVPs) (range 17 to 28). With more and less expensive telemonitoring interventions, standard of care remained more expensive. With 50% adherence to the intervention, standard of care was $89,848 more expensive. ConclusionsIn almost all probability and cost scenarios, a telemonitoring intervention is cost-saving for the management of cirrhotic ascites. Using hospital admissions as a surrogate for quality of care, patient outcomes are improved primarily though more proactive medical intervention and more LVPs.

Symptom Management in Patients with Cirrhosis: a Practical Guide

“…Bloom et al used weight telemonitoring to identify rapidly increasing or decreasing weight in patients with ascites. Using model analysis, for every 100 patients, telemonitoring led to a cost savings of > $150,000 over 6 months and prevented 9 hospital admissions [ 21 ].…”

Telemedicine in Hepatology: Current Applications and Future Directions

“…(58) Feasibility studies examining the use of telemonitoring in the management of ascites have also shown promise, and its use in routine management of patients with cirrhosis is an area that warrants additional research. (38) In addition to reducing hospitalization rates, these programs also appear to have the opportunity to reduce costs, primarily through more proactive medical interventions, (38) and reduce patient burden due to travel and lodging.…”

“…When compared with traditional routine care, a telemonitoring system, which tracked patients' weights remotely through Bluetooth-enabled scales, was estimated to reduce costs by US $167,500 for 100 patients with cirrhosis with ascites over a 6-month period and prevent 9 hospital admissions. (38) Even with only 50% adherence, standard of care was calculated to be significantly more expensive.…”

Monitoring for Ascites in Cirrhosis Using Patient-Generated Health Data: No Longer a Remote Possibility

“…Ascites is a particularly common and costly cirrhosis complication that has been the target of several interventions aimed to reduce hospitalization frequency and length by improving timely access to paracentesis and redesigning acute models of care [4,5]. Though telemedicine and "automated hovering" interventions are particularly promising modalities that can improve access to care and inbetween visit monitoring, the evidence base for their clinical effectiveness and optimal implementation is still building for cirrhosis [6,7].In this issue of Digestive Diseases and Sciences, Bloom et al evaluated the costs and outcomes of a telemonitoring intervention for ascites in cirrhosis [8]. The authors developed a decision-analytic model that examined payerperspective costs of a standard-of-care compared with a telemonitoring intervention among 100 simulated patients at a tertiary care center over a 6-month horizon.…”

“…In this issue of Digestive Diseases and Sciences, Bloom et al evaluated the costs and outcomes of a telemonitoring intervention for ascites in cirrhosis [8]. The authors developed a decision-analytic model that examined payerperspective costs of a standard-of-care compared with a telemonitoring intervention among 100 simulated patients at a tertiary care center over a 6-month horizon.…”