Cost–utility analysis of telemonitoring versus conventional hospital-based follow-up of patients with pacemakers. The NORDLAND randomized clinical trial

Abstract

The aim of our study was to perform an economic assessment in order to check whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics. Methods We used effectiveness and cost data from the NORDLAND trial, which is a controlled, randomized, non-masked clinical trial. Fifty patients were assigned to receive either telemonitoring (TM; n = 25) or conventional monitoring (CM; n = 25) and were followed up for 12 months after the implantation. A cost-utility analysis was performed in terms of additional costs per additional Quality-Adjusted Life Year (QALY) attained from the perspectives of the Norwegian National Healthcare System and patients and their caregivers. Results Effectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: €2,079.84 [CI: 0.00 to 4,610.58] vs. €271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: €2,295.91 [CI: 0.00 to 4,843.28] vs. CM: €430.39 [CI: 0.00 to 4,841.48]), although these large differences-mainly due to a few patients being hospitalized in the TM group, as opposed to none in the CM group-did not reach statistical significance. The Incremental Cost-Effectiveness Ratio (ICER) from the Norwegian NHS perspective (€53,345.27/QALY) and

Long-term cost-utility analysis of remote monitoring of older patients with pacemakers: the PONIENTE study

“…However, after a five-year follow-up period, this reduction of in-hospital visits failed to display a significant impact on the costs from the PHS perspective, with a cost saving of 16.13% per patient (€215.48 vs. €256.92; p = 0.112). Although a significant reduction in costs from the PHS perspective of 57.64% in the RM group (p < 0.001) was reported in our 12-months PONIENTE study [29]. This finding was in accordance with the previous studies [5,10,25,27,[43][44][45].…”

“…The last few years have witnessed an upsurge in the number of cost-effectiveness studies on cardiovascular implantable electronic devices [8,9,[21][22][23][24][25]. However, there have been only a few studies that analyzed cost-utility in terms of quantity and health-related quality of life (HRQL) of older patients, especially in the long-term [5,10,14,[26][27][28][29].…”

Knowledge Update on the Economic Evaluation of Pacemaker Telemonitoring Systems

“…After the first screening, the full texts of 124 relevant studies were reviewed. Out of these 11 articles [7,[42][43][44][45][46][47][48][49][50][51], corresponding to 10 different studies (references [49,51] belong to the same study), met the selection criteria (Figure 2) and were included in the subsequent synthesis of evidence. The references from the 113 excluded articles are available in the Supplementary Material (File S1).…”

“…This review included seven experimental [7,42,[47][48][49][50][51] and four descriptive/observational [43][44][45][46] studies and aimed to evaluate the results on quality of life, effectiveness, safety, reliability, and costs of TM of pacemakers compared with CM [7,[42][43][44][45][46][47][48][49][50][51].…”

“…The sample sizes of the studies varied (50-802 patients). The mean age of the patients in 10 of the publications [7,[43][44][45][46][47][48][49][50][51] was 71.85 ± 22.09 years (minimum age 12; maximum age 88). The major indication for pacemaker implantation was atrioventricular block [7,[44][45][46][47][48][49]51].…”