Effectiveness of a home telemonitoring program for patients with chronic obstructive pulmonary disease in Germany: Evidence from the first three years

Abstract

Introduction Chronic obstructive pulmonary disease (COPD) affects more than 6 million people in Germany. Monitoring the vital parameters of COPD patients remotely through telemonitoring may help doctors and patients prevent and treat acute exacerbations of COPD, improving patients’ quality of life and saving costs for the statutory health insurance system. Objective To evaluate the effects from October 2012 until December 2015 of a structured home telemonitoring program implemented by a statutory health insurer in Germany. Methods We conducted a retrospective cohort study using administrative data. After building a balanced control group using Entropy Balancing, we calculated difference-in-difference estimators to account for time-invariant heterogeneity. We estimated differences in mortality rates using Cox regression and conducted subgroup and sensitivity analyses to check the robustness of the base case results. We observed each patient in the program for up to 3 years depending on his or her time of enrolment. Results Among patients in the telemonitoring cohort, we observed significantly higher inpatient costs due to COPD (€524.2, p<0,05; €434.6, p<0.05) and outpatient costs (102.5, p<0.01; 78.8 p<0.05) during the first two years of the program. Additional cost categories were significantly increased during the first year of telemonitoring. We also observed a significantly higher number of drug prescriptions during all three years of the observation period (2.0500, p < 0.05; 0.7260, p < 0.05; 3.3170, p < 0.01) and a higher number of outpatient contacts during the first two years (0.945, p<0.01, 0.683, p<0.05). Furthermore, we found significantly improved survival rates for participants in the telemonitoring program (HR 0.68, p<0.001). Conclusion On one hand, telemonitoring was associated with higher health care expenditures, especially in the first year of the program. For example, we were able to identify a statistically significant increase in inpatient costs due to COPD, outpatient contacts and drug prescriptions among individuals participating in the telemonitoring program. On the other hand, the telemonitoring program was accompanied by a survival benefit, which might be related to higher adherence rates, more intense treatment, or an improved understanding of COPD among these patients.

Telemedicine and home monitoring for COPD – a narrative review of recent literature

“…Six of the included studies specifically focused on the effectiveness of telemonitoring programs [7–11,12 ▪▪ ]. The program of Gazzi et al [7] consisted of a 6-month tele-assistance multidisciplinary support program that included psychologist support and focused on monitoring clinical problems in patients with advanced cardiorespiratory diseases.…”

“…Two studies of home monitoring intervention focused on healthcare usage and costs. First, in the study of Hofer et al [12 ▪▪ ], a structured home telemonitoring program was evaluated. Interestingly, even though the telemonitoring program was accompanied by a survival benefit, which might be related to higher adherence rates, more intense treatment, or an improved understanding of COPD among these patients, it was also associated with the significantly higher inpatient costs due to COPD and a higher number of outpatient contacts during the first two years.…”

“…Two studies of home monitoring intervention focused on healthcare usage and costs. First, in the study of Hofer et al[12…”

Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review

“…Cabe destacar, además, que la telemonitorización es aceptable para los profesionales de la salud, requiere bajos costos de instalación y explotación 6 y es simple y de bajo riesgo para los pacientes 11 . En conjunto, estas observaciones indican que la telemonitorización domiciliaria puede facilitar la continuidad asistencial durante la transición del hospital al hogar y reducir las readmisiones tempranas post-hospitalización 12,13 , mejorar la supervivencia, probablemente debido a una mejor adherencia terapéutica o una mejor comprensión de la EPOC por parte de los pacientes 14 , mayor accesibilidad 15 y, potencialmente, el coste promedio por paciente 16 .…”

“…Sin embargo, estos resultados positivos contrastan con los de otros estudios que concluyen que la telemonitorización se asoció con un mayor gasto en salud 14 , que su implementación práctica no fue siempre factible, que no redujo la frecuencia de hospitalización por exacerbación de la EPOC, que precisaba de habilidades de automanejo, y que no mejoró la calidad de vida de los pacientes [17][18][19][20][21] , ni tuvo ningún efecto medible sobre su estado mental (depresión y ansiedad) 15 .…”