1
|
Monteiro R, Rabello GCM, Moreno CR, Moitinho MS, Pires FA, Samesina N, César LAM, Tarasoutchi F, Fernandes F, Martins PCCO, Mariano BM, Soeiro ADM, Palhares A, Pastore CA, Jatene FB. Enhancing cardiac postoperative care: a smartwatch-integrated remote telemonitoring platform for health screening with ECG analysis. Front Cardiovasc Med 2024; 11:1443998. [PMID: 39380627 PMCID: PMC11460294 DOI: 10.3389/fcvm.2024.1443998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/05/2024] [Indexed: 10/10/2024] Open
Abstract
Aims The integration of smartwatches into postoperative cardiac care transforms patient monitoring, systematically tracking vital signs and delivering real-time data to a centralized platform. This study focuses on developing a platform for seamless integration, assessing reliability, and evaluating the impact on post-cardiac surgery. The goal is to establish a robust foundation for understanding the efficacy and dependability of smartwatch-based telemonitoring, enhancing care for this population. Methods and results A total of 108 cardiac surgery patients were divided into telemonitoring (TLM) and control (CTL) groups. The TLM group utilized smartwatches for continuous monitoring of vital parameters (SpO2, HR, BP, ECG) over 30 ± 3 days. Statistical analyses (Pearson, Intraclass Correlation, Bland-Altman, Tost Test) were employed to compare smartwatch measurements with traditional methods. Significant correlations and concordance were observed, particularly in HR and BP measurements. Challenges were noted in SpO2 measurement. The ECG algorithm exhibited substantial agreement with cardiologists (Kappa: 0.794; p > 0.001), highlighting its reliability. The telemonitoring platform played a crucial role in early detection of clinical changes, including prompt Emergency Department (ED) visits, contributing significantly to preventing outcomes that could lead to mortality, such as asymptomatic Atrioventricular block. Positive patient responses affirmed technological efficacy, especially in identifying cardiac arrhythmias like atrial fibrillation. Conclusion The integration of smartwatches into remote telemonitoring for postoperative cardiac care demonstrates substantial potential, improving monitoring and early complication detection, thereby enhancing patient outcomes. The FAPO-X Study (Assisted Digital Telemonitoring with Wearables in Patients After Cardiovascular Surgery; NCT05966857) underscores the promising role of telemonitoring in postoperative cardiac care.
Collapse
Affiliation(s)
- Rosangela Monteiro
- Department of Cardiovascular Surgery—InovaInCor, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme C. M. Rabello
- Department of Cardiovascular Surgery—InovaInCor, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camila R. Moreno
- Department of Cardiovascular Surgery—InovaInCor, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Matheus S. Moitinho
- Department of Cardiovascular Surgery—InovaInCor, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fábio A. Pires
- Biomedical Informatics Laboratory, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Nelson Samesina
- Electrocardiography Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Antônio M. César
- Chronic Coronary Disease Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Flávio Tarasoutchi
- Valvular Heart Disease Clinical Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fábio Fernandes
- Cardiomyopathy-Aortic Diseases Clinical Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- InCor Emergency Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Pietro C. C. O. Martins
- Department of Cardiovascular Surgery—InovaInCor, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bruna M. Mariano
- Department of Cardiovascular Surgery—InovaInCor, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre de M. Soeiro
- InCor Emergency Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Palhares
- Biomedical Informatics Laboratory, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Alberto Pastore
- Electrocardiography Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fabio B. Jatene
- Department of Cardiovascular Surgery—InovaInCor, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Wańczura P, Aebisher D, Wiśniowski M, Kos M, Bukowski H, Golicki D, Przybylski A. Cost-Utility Analysis of 3-Month Telemedical Intervention for Heart Failure Patients: A Preliminary Study from Poland. Healthcare (Basel) 2024; 12:1360. [PMID: 38998893 PMCID: PMC11240905 DOI: 10.3390/healthcare12131360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
Heart failure (HF) is a common clinical syndrome in which the cardiac systolic and/or diastolic functions are significantly insufficient, resulting in an inadequate pump function. Currently, it is one of the leading causes of human death and/or hospitalization, and it has become a serious global public health problem. Approximately 1.2 million people in Poland suffer from HF, and approximately 140,000 of them die every year. In this article, we present the result of telemedicine intervention and its cost-effectiveness in a group of patients from a pilot program on telemedicine and e-health solutions reducing social inequalities in the field of cardiology. Based on the EQ-5D-5L questionnaire administered in the beginning of the project and after approximately 3 months, used for the health state utility values calculation, cost estimates of the project, and inclusion of supplementary data, the economic rationale behind telemedical intervention in HF patients using a cost-utility analysis was corroborated. The choice of a 3-month project duration was due to the top-down project assumptions approved by the bioethics committee. The average improvement in health state utility values was statistically significant, implying a 0.01 QALY improvement per patient. The cost of the telemedical intervention per QALY was well within the official limit adopted as a cost-effective therapy measure in Poland.
Collapse
Affiliation(s)
- Piotr Wańczura
- Department of Cardiology, Medical College of Sciences, The Rzeszów University, 35-310 Rzeszow, Poland
- The Ministry of Internal Affairs and Administration Hospital, 35-111 Rzeszow, Poland
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College, University of Rzeszów, 35-310 Rzeszow, Poland
| | - Mateusz Wiśniowski
- The Ministry of Internal Affairs and Administration Hospital, 35-111 Rzeszow, Poland
| | - Marek Kos
- Department of Public Health, Medical University of Lublin, 20-400 Lublin, Poland
| | - Hubert Bukowski
- Institute of Innovation and Responsible Development, 02-621 Warsaw, Poland
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Andrzej Przybylski
- Department of Cardiology, Medical College of Sciences, The Rzeszów University, 35-310 Rzeszow, Poland
| |
Collapse
|
3
|
Zakiyah N, Marulin D, Alfaqeeh M, Puspitasari IM, Lestari K, Lim KK, Fox-Rushby J. Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review. J Med Internet Res 2024; 26:e53500. [PMID: 38687991 PMCID: PMC11094606 DOI: 10.2196/53500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. OBJECTIVE This study's objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. METHODS A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. RESULTS Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48%), trials (13/27, 48%), or a combination approach (1/27, 4%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89%) used cost-utility analysis. The majority of the studies (25/27, 93%) were conducted in high-income countries, particularly European countries (16/27, 59%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74%), moderate (6/27, 22%), or excellent (1/27, 4%). CONCLUSIONS Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. TRIAL REGISTRATION PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc.
Collapse
Affiliation(s)
- Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Dita Marulin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Mohammed Alfaqeeh
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Irma Melyani Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Keri Lestari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Ka Keat Lim
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Julia Fox-Rushby
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| |
Collapse
|
4
|
Jiu L, Wang J, Javier Somolinos-Simón F, Tapia-Galisteo J, García-Sáez G, Hernando M, Li X, Vreman RA, Mantel-Teeuwisse AK, Goettsch WG. A literature review of quality assessment and applicability to HTA of risk prediction models of coronary heart disease in patients with diabetes. Diabetes Res Clin Pract 2024; 209:111574. [PMID: 38346592 DOI: 10.1016/j.diabres.2024.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
This literature review had two objectives: to identify models for predicting the risk of coronary heart diseases in patients with diabetes (DM); and to assess model quality in terms of risk of bias (RoB) and applicability for the purpose of health technology assessment (HTA). We undertook a targeted review of journal articles published in English, Dutch, Chinese, or Spanish in 5 databases from 1st January 2016 to 18th December 2022, and searched three systematic reviews for the models published after 2012. We used PROBAST (Prediction model Risk Of Bias Assessment Tool) to assess RoB, and used findings from Betts et al. 2019, which summarized recommendations and criticisms of HTA agencies on cardiovascular risk prediction models, to assess model applicability for the purpose of HTA. As a result, 71 % and 67 % models reporting C-index showed good discrimination abilities (C-index >= 0.7). Of the 26 model studies and 30 models identified, only one model study showed low RoB in all domains, and no model was fully applicable for HTA. Since the major cause of high RoB is inappropriate use of analysis method, we advise clinicians to carefully examine the model performance declared by model developers, and to trust a model if all PROBAST domains except analysis show low RoB and at least one validation study conducted in the same setting (e.g. country) is available. Moreover, since general model applicability is not informative for HTA, novel adapted tools may need to be developed.
Collapse
Affiliation(s)
- Li Jiu
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands
| | - Junfeng Wang
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands
| | - Francisco Javier Somolinos-Simón
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Jose Tapia-Galisteo
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain; CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Gema García-Sáez
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain; CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Mariaelena Hernando
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain; CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Xinyu Li
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands; University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Broerstraat 5, 9712 CP Groningen, the Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands; National Health Care Institute (ZIN), Diemen, Willem Dudokhof 1, 1112 ZA Diemen, Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands; National Health Care Institute (ZIN), Diemen, Willem Dudokhof 1, 1112 ZA Diemen, Netherlands.
| |
Collapse
|
5
|
Liu T, Zhan Y, Chen S, Zhang W, Jia J. Cost-effectiveness analysis of digital therapeutics for home-based cardiac rehabilitation for patients with chronic heart failure: model development and data analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:82. [PMID: 37932748 PMCID: PMC10626728 DOI: 10.1186/s12962-023-00489-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In recent years, numerous guidelines and expert consensus have recommended the inclusion of digital technologies and products in cardiac rehabilitation. Digital therapeutics (DTx) is an evidence-based medicine that uses digital means for data collection and monitoring of indicators to control and optimize the treatment, management, and prevention of disease. OBJECTIVE This study collected and reviewed real-world data and built a model using health economics assessment methods to analyze the potential cost-effectiveness of DTx applied to home-based cardiac rehabilitation for patients with chronic heart failure. From the perspective of medical and health decision-makers, the economic value of DTx is evaluated prospectively to provide the basis and reference for the application decision and promotion of DTx. METHODS Markov models were constructed to simulate the outcomes of DTx for home-based cardiac rehabilitation (DT group) compared to conventional home-based cardiac rehabilitation (CH group) in patients with chronic heart failure. The model input parameters were clinical indicators and cost data. Outcome indicators were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The robustness of the evaluation methods and results was tested using sensitivity analyses. Clinical indicators, cost data, and health utility values were obtained from real-world data, including clinical study data, published literature, and public website information. RESULTS The Markov model simulated a time span of 10 years, with a cycle set at one month, for 120 cycles. The results showed that the per capita cost of the CH group was 38,442.11 CNY/year, with a QALY of 0.7196 per person per year. The per capita cost of the DT group was 42,300.26 CNY/year, with a QALY of 0.81687 per person per year. The ICER per person was 39,663.5 CNY/QALY each year, which was below the willingness-to-pay threshold of 85,698 CNY (China's GDP per capita in 2022). CONCLUSIONS DTx for home-based cardiac rehabilitation is an extremely cost-effective rehabilitation option compared with conventional home-based cardiac rehabilitation. DTx for home-based cardiac rehabilitation is potentially valuable from the perspective of healthcare decision-makers.
Collapse
Affiliation(s)
- Tianyi Liu
- School of Business, Nanjing University, Nanjing, 210093, China
| | - Yiyang Zhan
- Departments of Geriatric Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Silei Chen
- Medical School, Nanjing University, Nanjing, China
| | - Wenhong Zhang
- School of Business, Nanjing University, Nanjing, 210093, China.
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China.
| | - Jian Jia
- School of Business, Nanjing University, Nanjing, 210093, China.
- Departments of General Practice, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
6
|
Ong SWX, Zhabokritsky A, Daneman N, Tong SYC, Wijeysundera HC. Evaluating the use of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the workup of Staphylococcus aureus bacteraemia: a cost-utility analysis. Clin Microbiol Infect 2023; 29:1417-1423. [PMID: 37353076 DOI: 10.1016/j.cmi.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES The use of positron emission tomography/computed tomography (PET/CT) in the evaluation of patients with Staphylococcus aureus bacteraemia can improve the diagnosis of infectious foci and guide clinical management. We aimed to evaluate the cost-utility of PET/CT among adults hospitalized with Staphylococcus aureus bacteraemia. METHODS A cost-utility analysis was conducted from the healthcare payer perspective using a probabilistic Markov cohort model assessing three diagnostic strategies: (a) PET/CT in all patients, (b) PET/CT in high-risk patients only, and (c) routine diagnostic workup. Primary outcomes were quality-adjusted life years (QALYs), costs in Canadian dollars, and an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty. RESULTS Routine workup resulted in an average of 16.64 QALYs from the time of diagnosis at a lifetime cost of $209 060/patient. This was dominated by PET/CT in high-risk patients (i.e. greater effectiveness at lower costs) with average 16.88 QALYs at a cost of $199 552. Compared with PET/CT in high-risk patients only, PET/CT for all patients cost on average $11 960 more but resulted in 0.14 more QALYs, giving an incremental cost-effectiveness ratio of $83 500 (cost per additional QALY gained); however, there was a high degree of uncertainty comparing these two strategies. At a willingness-to-pay threshold of $50 000/QALY, PET/CT in high-risk patients was the most cost-effective strategy in 58.6% of simulations vs. 37.9% for PET/CT in all patients. DISCUSSION Our findings suggest that a strategy of using PET/CT in high-risk patients is more cost-effective than no PET/CT. Randomized controlled trials should be conducted to evaluate the use of PET/CT in different patient groups.
Collapse
Affiliation(s)
- Sean W X Ong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
| | - Alice Zhabokritsky
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Nick Daneman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Steven Y C Tong
- Department of Infectious Diseases, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
7
|
De Guzman KR, Snoswell CL, Taylor ML, Gray LC, Caffery LJ. Economic Evaluations of Remote Patient Monitoring for Chronic Disease: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:897-913. [PMID: 35667780 DOI: 10.1016/j.jval.2021.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care. METHODS A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis. CONCLUSIONS RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions.
Collapse
Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Leonard C Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| |
Collapse
|
8
|
Luo X, Xu W, Ming WK, Jiang X, Yuan Q, Lai H, Huang C, Zhong X. Cost-Effectiveness of Mobile Health-Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis. J Med Internet Res 2022; 24:e29408. [PMID: 35438646 PMCID: PMC9066334 DOI: 10.2196/29408] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/23/2021] [Accepted: 02/24/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). OBJECTIVE The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. METHODS A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. RESULTS In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. CONCLUSIONS This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation.
Collapse
Affiliation(s)
- Xueyan Luo
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- School of Biological and Chemical Engineering, Chongqing University of Education, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Wei Xu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjin, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong, Hong Kong
| | - Xinchan Jiang
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Quan Yuan
- Chong Qing Pharmaceutical Group Co Ltd, Chongqing, China
| | - Han Lai
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Chunji Huang
- School of Basic Medical Science, Army Medical University, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| |
Collapse
|
9
|
The New Role of Telehealth in Contemporary Medicine. Curr Cardiol Rep 2022; 24:271-275. [PMID: 35218502 PMCID: PMC8881748 DOI: 10.1007/s11886-022-01640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review Understand the current uses for telehealth as well as future directions as it relates to the COVID-19 pandemic and cardiovascular medicine. Recent Findings Telehealth interventions in various forms have proven to be efficacious in the management of obesity, hypertension, glycemic control in diabetes, hyperlipidemia, medication adherence, and ICU length of stay and mortality. The use and study of such interventions have been greatly expanded during the pandemic partly due to the expanded coverage by payers. However, heterogenous interventions and a relative lack of cost analyses are barriers to more widespread adoption. Summary Telehealth has proven efficacy for modifying risk factors for cardiovascular disease. To date, this has not been shown to translate to a reduction in hard cardiovascular endpoints such as mortality. With ongoing research and expanded funding, the role of telehealth is likely to evolve as the COVID pandemic continues.
Collapse
|
10
|
Jiang X, Yao J, You JHS. Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis. J Med Internet Res 2021; 23:e26516. [PMID: 33656440 PMCID: PMC7931824 DOI: 10.2196/26516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). OBJECTIVE We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. METHODS A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. RESULTS In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.
Collapse
Affiliation(s)
- Xinchan Jiang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Jiaqi Yao
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joyce Hoi-Sze You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| |
Collapse
|