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Caillon M, Sabatier R, Legallois D, Courouve L, Donio V, Boudevin F, de Chalus T, Hauchard K, Belin A, Milliez P. A telemonitoring programme in patients with heart failure in France: a cost-utility analysis. BMC Cardiovasc Disord 2022; 22:441. [PMID: 36217130 PMCID: PMC9549824 DOI: 10.1186/s12872-022-02878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. METHODS A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three 'not hospitalised' states, two 'hospitalisation for heart failure' states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. RESULTS The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. CONCLUSIONS Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.
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Affiliation(s)
| | - Rémi Sabatier
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
| | | | | | | | | | | | - Annette Belin
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Paul Milliez
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
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Michael Robie E, Cole S, Suwal A, Coustasse A. Tele-ICU in the Unites States: Is a cost-effective model? INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2040877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E. Michael Robie
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Stephanie Cole
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Archana Suwal
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
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Sülz S, van Elten HJ, Askari M, Weggelaar-Jansen AM, Huijsman R. eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations. J Med Internet Res 2021; 23:e24363. [PMID: 33687335 PMCID: PMC7988395 DOI: 10.2196/24363] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND eHealth applications are constantly increasing and are frequently considered to constitute a promising strategy for cost containment in health care, particularly if the applications aim to support older persons. Older persons are, however, not the only major eHealth stakeholder. eHealth suppliers, caregivers, funding bodies, and health authorities are also likely to attribute value to eHealth applications, but they can differ in their value attribution because they are affected differently by eHealth costs and benefits. Therefore, any assessment of the value of eHealth applications requires the consideration of multiple stakeholders in a holistic and integrated manner. Such a holistic and reliable value assessment requires a profound understanding of the application's costs and benefits. The first step in measuring costs and benefits is identifying the relevant costs and benefit categories that the eHealth application affects. OBJECTIVE The aim of this study is to support the conceptual phase of an economic evaluation by providing an overview of the relevant direct and indirect costs and benefits incorporated in economic evaluations so far. METHODS We conducted a systematic literature search covering papers published until December 2019 by using the Embase, Medline Ovid, Web of Science, and CINAHL EBSCOhost databases. We included papers on eHealth applications with web-based contact possibilities between clients and health care providers (mobile health apps) and applications for self-management, telehomecare, telemedicine, telemonitoring, telerehabilitation, and active healthy aging technologies for older persons. We included studies that focused on any type of economic evaluation, including costs and benefit measures. RESULTS We identified 55 papers with economic evaluations. These studies considered a range of different types of costs and benefits. Costs pertained to implementation activities and operational activities related to eHealth applications. Benefits (or consequences) could be categorized according to stakeholder groups, that is, older persons, caregivers, and health care providers. These benefits can further be divided into stakeholder-specific outcomes and resource usage. Some cost and benefit types have received more attention than others. For instance, patient outcomes have been predominantly captured via quality-of-life considerations and various types of physical health status indicators. From the perspective of resource usage, a strong emphasis has been placed on home care visits and hospital usage. CONCLUSIONS Economic evaluations of eHealth applications are gaining momentum, and studies have shown considerable variation regarding the costs and benefits that they include. We contribute to the body of literature by providing a detailed and up-to-date framework of cost and benefit categories that any interested stakeholder can use as a starting point to conduct an economic evaluation in the context of independent living of older persons.
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Affiliation(s)
- Sandra Sülz
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Hilco J van Elten
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Marjan Askari
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
- Clinical Informatics, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, Rotterdam, Netherlands
- Geriant, Heerhugowaard, Netherlands
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Kerr B, Pharithi RB, Barrett M, Halley C, Gallagher J, Ledwidge M, McDonald K. Changing to remote management of a community heart failure population during COVID-19 - Clinician and patient perspectives'. IJC HEART & VASCULATURE 2020; 31:100665. [PMID: 33106775 PMCID: PMC7577653 DOI: 10.1016/j.ijcha.2020.100665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID pandemic has challenged the traditional methods used in care of patients with heart failure (HF). Remote management of HF patients has been recommended in order to maintain routine standards of care, but satisfaction with this platform of care is unknown. We set out to address the physician and patient opinion of remote management of HF during COVID-19. METHODS AND RESULTS An observational report of the use of a Structured Telephonic assessment (STA) in stable outpatient HF patients. Physician grading of the STA was complemented by 100 randomly chosen patients to ascertain patient satisfaction and comment. 278 patients underwent a STA. Patient preference for STA was noted in 66%. Convenience was the single most cited reason for this preference (83.3%). The STA was deemed satisfactory by clinicians in 67.6%. The two-leading reasons for clinician dissatisfaction were data gaps providing a barrier to titration (55.6%) and need for clinical exam (18.9%). The annual review appointment visit subtype possessed the highest levels of satisfaction congruence amongst both clinicians and patients. CONCLUSION In summary, this report demonstrates reasonable patient / physician satisfaction with STA, and provides some direction on how this care platform might be sustained beyond the COVID crisis.
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Key Words
- ARA, Annual review appointment
- BP, Blood pressure
- COVID-19
- DMP, Disease management programme
- F2F, Face to Face
- GP, General practitioner
- HF, Heart Failure
- HFrEF, Heart failure with reduced ejection fraction
- HR, Heart Rate
- HRPA, High risk patient appointment
- Heart failure
- Remote patient monitoring
- STA, Structured telephone assessment
- Telemedicine
- VC, Virtual consult
- YRS, Years
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Affiliation(s)
- Brian Kerr
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Rebabonye B. Pharithi
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Matthew Barrett
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
| | - Carmel Halley
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
| | - Joe Gallagher
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Mark Ledwidge
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Kenneth McDonald
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
- School of Medicine, University College Dublin, Dublin 4, Ireland1
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Boodoo C, Zhang Q, Ross HJ, Alba AC, Laporte A, Seto E. Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis. J Med Internet Res 2020; 22:e18917. [PMID: 33021485 PMCID: PMC7576467 DOI: 10.2196/18917] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. OBJECTIVE This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. METHODS Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly's effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. RESULTS The Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. CONCLUSIONS The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.
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Affiliation(s)
- Chris Boodoo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Qi Zhang
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Ana Carolina Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Canadian Centre for Health Economics, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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Jiang X, Yao J, You JH. Telemonitoring Versus Usual Care for Elderly Patients With Heart Failure Discharged From the Hospital in the United States: Cost-Effectiveness Analysis. JMIR Mhealth Uhealth 2020; 8:e17846. [PMID: 32407288 PMCID: PMC7381019 DOI: 10.2196/17846] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Telemonitoring-guided interventional management reduces the need for hospitalization and mortality of patients with chronic heart failure (CHF). Objective This study aimed to analyze the cost-effectiveness of usual care with and without telemonitoring-guided management in patients with CHF discharged from the hospital, from the perspective of US health care providers. Methods A lifelong Markov model was designed to estimate outcomes of (1) usual care alone for all postdischarge patients with CHF (New York Heart Association [NYHA] class I-IV), (2) usual care and telemonitoring for all postdischarge patients with CHF, (3) usual care for all postdischarge patients with CHF and telemonitoring for patients with NYHA class III to IV, and (4) usual care for all postdischarge patients with CHF plus telemonitoring for patients with NYHA class II to IV. Model inputs were derived from the literature and public data. Sensitivity analyses were conducted to assess the robustness of model. The primary outcomes were total direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Results In the base case analysis, universal telemonitoring group gained the highest QALYs (6.2967 QALYs), followed by the telemonitoring for NYHA class II to IV group (6.2960 QALYs), the telemonitoring for NYHA class III to IV group (6.2450 QALYs), and the universal usual care group (6.1530 QALYs). ICERs of the telemonitoring for NYHA class III to IV group (US $35,393 per QALY) and the telemonitoring for NYHA class II to IV group (US $38,261 per QALY) were lower than the ICER of the universal telemonitoring group (US $100,458 per QALY). One-way sensitivity analysis identified five critical parameters: odds ratio of hospitalization for telemonitoring versus usual care, hazard ratio of all-cause mortality for telemonitoring versus usual care, CHF hospitalization cost and monthly outpatient costs for NYHA class I, and CHF hospitalization cost for NYHA class II. In probabilistic sensitivity analysis, probabilities of the universal telemonitoring, telemonitoring for NYHA class II to IV, telemonitoring for NYHA class III to IV, and universal usual care groups to be accepted as cost-effective at US $50,000 per QALY were 2.76%, 76.31%, 18.6%, and 2.33%, respectively. Conclusions Usual care for all discharged patients with CHF plus telemonitoring-guided management for NYHA class II to IV patients appears to be the preferred cost-effective strategy.
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Affiliation(s)
- Xinchan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Jiaqi Yao
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Joyce Hs You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
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Vestergaard AS, Hansen L, Sørensen SS, Jensen MB, Ehlers LH. Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial. BMJ Open 2020; 10:e031670. [PMID: 31992604 PMCID: PMC7045102 DOI: 10.1136/bmjopen-2019-031670] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/20/2019] [Accepted: 01/02/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed to assess the cost-effectiveness of telehealthcare in heart failure patients as add-on to usual care. DESIGN A cost-utility analysis was conducted from a public payer perspective alongside the randomised controlled TeleCare North trial. SETTING The North Denmark Region, Denmark. PARTICIPANTS The study included 274 heart failure patients with self-reported New York Heart Association class II-IV. INTERVENTIONS Patients in the intervention group were provided with a Telekit consisting of a tablet, a digital blood pressure monitor, and a scale and were instructed to perform measurements one to two times a week. The responsibility of the education, instructions and monitoring of the heart failure (HF) patients was placed on municipality nurses trained in HF and telemonitoring. Both groups received usual care. OUTCOME MEASURES Cost-effectiveness was reported as incremental net monetary benefit (NMB). A micro-costing approach was applied to evaluate the derived savings in the first year in the public health sector. Quality-adjusted life-years (QALY) gained were estimated using the EuroQol 5-Dimensions 5-Levels questionnaire at baseline and at a 1-year follow-up. RESULTS Data for 274 patients were included in the main analysis. The telehealthcare solution provided a positive incremental NMB of £5164. The 1-year adjusted QALY difference between the telehealthcare solution and the usual care group was 0.0034 (95% CI: -0.0711 to 0.0780). The adjusted difference in costs was -£5096 (95% CI: -8736 to -1456) corresponding to a reduction in total healthcare costs by 35%. All sensitivity analyses showed the main results were robust. CONCLUSIONS The TeleCare North solution for monitoring HF was highly cost-effective. There were significant cost savings on hospitalisations, primary care contacts and total costs. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02860013.
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Affiliation(s)
- Anne Sig Vestergaard
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
| | - Louise Hansen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
| | - Sabrina Storgaard Sørensen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
| | | | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark
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Remote Monitoring of Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy and Permanent Pacemakers: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2018; 18:1-199. [PMID: 30443279 PMCID: PMC6235077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Under usual care, people with an implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy with or without a defibrillator (CRT-D and CRT-P, respectively), or a permanent pacemaker have follow-up in-person clinic visits. Remote monitoring of these devices allows the transfer of the information stored in the device so that it can be accessed by the clinic personnel via a secured website. METHODS We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for remote monitoring of ICDs, CRTs, and permanent pacemakers plus clinic visits compared with clinic visits alone. This is an update of a 2012 health technology assessment. In addition to the eligible randomized controlled trials (RCTs) from the 2012 publication, we included RCTs identified through a systematic literature search on June 1, 2017. We assessed the risk of bias of each study using the Cochrane risk of bias tool and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We conducted an economic evaluation to determine the cost-effectiveness of remote monitoring blended with in-clinic follow-up compared to in-clinic follow-up alone in patients with an ICD, a CRT-D, or a pacemaker. We determined the budget impact of blended remote monitoring in patients implanted with ICD, CRT-D, CRT-P, or pacemaker devices from the perspective of the Ontario Ministry of Health and Long-Term Care. To understand patient experiences with remote monitoring, we interviewed 16 patients and family members. RESULTS Based on 15 RCTs in patients with implanted ICDs or CRT-Ds, remote monitoring plus clinic visits resulted in fewer patients with inappropriate ICD shocks within 12 to 37 months of follow-up (moderate quality evidence; absolute risk difference -0.04 [95% confidence interval -0.07 to -0.01]), fewer total clinic visits (moderate quality evidence), and a shorter time to detection and treatment of events (moderate quality evidence) compared with clinic visits alone. There was a similar risk of major adverse events (moderate quality evidence).Based on 6 RCTs in patients with pacemakers, remote monitoring plus clinic visits reduced the arrhythmia burden (high quality evidence), the time to detection and treatment of arrhythmias (high quality evidence), and the number of clinic visits (moderate quality evidence]) compared with clinic visits alone. Here again, there was a similar risk of major adverse events (high quality evidence).Results from the economic evaluation showed that among ICD and CRT-D recipients, blended remote monitoring (remote monitoring plus in-clinic follow ups) was more costly (incremental value of $4,354 per person) and more effective, providing higher quality-adjusted life years (incremental value of 0.19), compared to in-clinic follow-up alone. Among pacemaker recipients, blended remote monitoring was less costly (with an incremental saving of $2,370 per person) and more effective (with an incremental value of 0.12 quality-adjusted life years) than with in-clinic follow-up alone. We estimated that publicly funding remote monitoring could result in cost savings of $14 million over the first five years.Participants using remote monitoring reported that these devices provide important medical and safety benefits in managing their heart condition. Remote cardiac monitoring provides patients and their family members with an increased freedom. Their belief that the device will help with earlier detection of technical or clinical problems reduces the amount of stress and distraction their condition causes in their lives. CONCLUSIONS Remote monitoring of ICDs, CRT-Ds, and pacemakers plus clinic visits resulted in improved outcomes without increasing the risk of major adverse events compared with clinic visits alone. Remote monitoring is a cost-effective option for patients implanted with cardiac electronic devices. Patients reported positive experiences using remote monitoring, and perceived that the device provided important medical and safety benefits.
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Greenhalgh T, A’Court C, Shaw S. Understanding heart failure; explaining telehealth - a hermeneutic systematic review. BMC Cardiovasc Disord 2017; 17:156. [PMID: 28615004 PMCID: PMC5471857 DOI: 10.1186/s12872-017-0594-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/07/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. METHODS Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. RESULTS Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. CONCLUSION The limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Christine A’Court
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG UK
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Gensini GF, Alderighi C, Rasoini R, Mazzanti M, Casolo G. Value of Telemonitoring and Telemedicine in Heart Failure Management. Card Fail Rev 2017; 3:116-121. [PMID: 29387464 DOI: 10.15420/cfr.2017:6:2] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The use of telemonitoring and telemedicine is a relatively new but quickly developing area in medicine. As new digital tools and applications are being created and used to manage medical conditions such as heart failure, many implications require close consideration and further study, including the effectiveness and safety of these telemonitoring tools in diagnosing, treating and managing heart failure compared to traditional face-to-face doctor-patient interaction. When compared to multidisciplinary intervention programs which are frequently hindered by economic, geographic and bureaucratic barriers, non-invasive remote monitoring could be a solution to support and promote the care of patients over time. Therefore it is crucial to identify the most relevant biological parameters to monitor, which heart failure sub-populations may gain real benefits from telehealth interventions and in which specific healthcare subsets these interventions should be implemented in order to maximise value.
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Affiliation(s)
| | | | - Raffaele Rasoini
- Fiorentino Institute of Care and Assistance (IFCA),Florence, Italy
| | - Marco Mazzanti
- International Research Framework on Artificial Intelligence in Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust,London, UK
| | - Giancarlo Casolo
- Cardiology Unit, New Versilia Hospital,Lido di Camaiore (LU), Italy
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