Economic cost of home-telemonitoring care for BiPAP-assisted ALS individuals

Abstract

Our objective was to measure direct (hospital and NHS) and indirect (patient/caregiver) costs of following up in-home compliance to non-invasive ventilation via wireless modem. We constructed a prospective controlled trial of 40 consecutive ALS home-ventilated patients, randomly assigned according to their residence area to G1 (nearby hospital, office-based follow-up) and G2 (outside hospital area, telemetry device-based follow-up). Total NHS direct cost encompassed costs related to outpatients' visits (office and emergency room) and hospitalizations. Hospital direct costs included transportation to/from hospital, office visit per hour cost and equipment maintenance. Non-medical costs considered days of wages lost due to absenteeism. G1 included 20 patients aged 60 ± 10 years and G2 included 19 patients aged 62 ± 13 years. Results showed that no differences were found regarding clinical/demographic characteristics at admission. NHS costs showed a 55% reduction in average total costs with a statistically significant decrease of 81% in annual costs per patient in G2. Hospital costs were found to be significantly higher in G2 with regard to total costs (64% average increase) but not annual costs (7%). No statistical difference was found with regard to expenses from absenteeism. In conclusion, at the cost of an initial financial constraint to the hospital per year (non-significant), telemonitoring is cost-effective, representing major cost savings to the NHS in the order of 700 euros/patient/year.

Using technology to improve access to specialist care in amyotrophic lateral sclerosis: A systematic review

“…The Lisbon pilot trial reported that telehealth was associated with significantly fewer outpatient, emergency room and hospital visits, but conclusions should be made with caution given the limitations in methodology (44,45). There was a trend towards longer survival in the telehealth group, but median time between symptom onset and starting NIV was much longer in the telehealth group suggesting that these patients had a slower disease course than those in the control group.…”

“…In the Lisbon study (after adjusting for survival by dividing the total health costs by the number of days using NIV) healthcare costs in the telehealth group were significantly lower due to reduced inpatient and transport costs (44,45). These results should be interpreted with caution as baseline characteristics differed and patients were assigned a study arm based on whether they lived in a rural or urban location -a factor that may independently influence health resource use.…”

“…Forty patients with ALS commencing non-invasive ventilation were recruited into a pilot trial and economic evaluation prior to developing respiratory failure (44,45).…”

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement

“…This study showed also that tele-monitoring might offer potential favourable effects on costs, survival and functional status. A study [10] showed the easy use of a tele-monitoring device, whereas another study [6] showed that tele-monitoring was cost-effective as compared to office-based follow-up control visits with a €700 patient year cost saving. Tele-monitoring has been used also in other NMD.…”

“…Home mechanical ventilators are sometimes equipped with remote monitoring tools in order to improve supervision on the delivered treatment and adapt settings to the patient's need and comfort accordingly [5]. The economic issues of home tele-monitoring are crucial for its rapid transfer to healthcare systems both in terms of cost/benefit ratio and in term of reimbursing rules [6]. An assessment of the costs associated to such an innovative application should be investigated in detail, together with regulatory (legal, insurance and reimbursement) issues.…”