Economic impact of remote patient monitoring: an integrated economic model derived from a meta‐analysis of randomized controlled trials in heart failure

Abstract

AimsTo assess the cost-effectiveness and the cost utility of remote patient monitoring (RPM) when compared with the usual care approach based upon differences in the number of hospitalizations, estimated from a meta-analysis of randomized clinical trials (RCTs). Methods and resultsWe reviewed the literature published between January 2000 and September 2009 on multidisciplinary heart failure (HF) management, either by usual care or RPM to retrieve the number of hospitalizations and length of stay (LOS) for HF and for any cause. We performed a meta-analysis of 21 RCTs (5715 patients). Remote patient monitoring was associated with a significantly lower number of hospitalizations for HF [incidence rate ratio (IRR): 0.77, 95% CI 0.65-0.91, P , 0.001] and for any cause (IRR: 0.87, 95% CI: 0.79-0.96, P ¼ 0.003), while LOS was not different. Direct costs for hospitalization for HF were approximated by diagnosis-related group (DRG) tariffs in Europe and North America and were used to populate an economic model. The difference in costs between RPM and usual care ranged from E300 to E1000, favouring RPM. These cost savings combined with a quality-adjusted life years (QALYs) gain of 0.06 suggest that RPM is a 'dominant' technology over existing standard care. In a budget impact analysis, the adoption of an RPM strategy entailed a progressive and linear increase in costs saved. ConclusionsThe novel cost-effectiveness data coupled with the demonstrated clinical efficacy of RPM should encourage its acceptance amongst clinicians and its consideration by third-party payers. At the same time, the scientific community should acknowledge the lack of prospectively and uniformly collected economic data and should request that future studies incorporate economic analyses.--

Use of Remote Monitoring of Newly Implanted Cardioverter-Defibrillators

“…18,19 In clinical studies, RPM use has been demonstrated to reduce resource use, and it may improve safety and patient outcomes. [3][4][5][6][12][13][14][15][16][17] However, whether these findings apply to the real-world clinical experience is unknown. Our findings suggest that physician and hospital factors play an important and potentially modifiable role in determining who is enrolled into an RPM system.…”

Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?

“…These cost savings, combined with a modest gain of 0.06 of a qualityadjusted life-year per patient, indicated that remote patient monitoring was worthwhile. 63 Telemedicine applications such as "teledermatology" have also shown promise as cost-saving services, with outcomes at least as good as those observed with conventional care. 64 With the worldwide explosion in the use of mobile phones as well as growing internet access through mobile data services, low-and middle-income countries increasingly have the opportunity to benefit from SMS-based services, live and asynchronous telemedicine, and interactive voice response calls.…”

Home Monitoring Heart Failure Care Does Not Improve Patient Outcomes

“…In particular, it has been suggested that remote monitoring might provide a more automated, centralized, cost-effective, and scalable approach to postdischarge support, focusing nursing attention on those patients with early evidence of clinical deterioration. 14,22 Telemonitoring Is Not Enough Home monitoring of heart failure patients typically takes 1 of 2 forms: Structured telephone support, in which providers (typically specialized nurses) schedule routine telephone contacts with patients for ongoing assessment, and telemonitoring, in which physiological data (including weight, heart rate, blood pressure, and the like) are transferred automatically to a healthcare provider via a wireless or broadband connection, with targeted follow-up triggered by variances that exceed preset thresholds. Although several randomized trials have been conducted evaluating home monitoring approaches as adjuncts to routine care, the data regarding their efficacy are mixed (Table).…”