JMIR Publications

ABSTRACT

Background:

Algorithm-enabled remote monitoring, using cardiac implantable electronic devices (CIEDs), is increasingly used to support earlier detection of clinical deterioration in heart failure and at-risk populations. However, the economic value of these technologies remains uncertain due to variation in intervention design, implementation, and evaluation methods.

Objective:

To systematically identify, appraise, and synthesise full economic evaluations of algorithm-enabled CIED remote monitoring in adults with established heart failure or at risk of heart failure.

Methods:

A systematic review was conducted in accordance with PRISMA 2020. Searches were performed in MEDLINE, EMBASE, Scopus, Web of Science, and the Cochrane Library, with supplementary searches of health technology assessment sources. Eligible studies reported full economic evaluations of algorithm-enabled remote monitoring linked to CIEDs. Data were extracted using a structured form and synthesised narratively due to heterogeneity. Methodological and reporting quality were assessed using the CHEQUE checklist and CHEERS 2022 statement.

Results:

Twelve studies were included, comprising model-based evaluations, trial-based analyses, observational studies, and health technology assessments. Substantial heterogeneity was observed in population definitions, intervention characteristics, algorithm types, monitored parameters, clinical response pathways, and economic methods. Cost-effectiveness and cost-utility analyses were most common, with time horizons ranging from short-term follow-up to lifetime modelling. Several studies reported economically favourable findings, including dominance or cost-effectiveness. However, outcomes varied across studies, and favourable estimates were often driven by assumptions about reduced hospitalisation and length of stay, while QALY gains were generally modest. Reporting of key implementation factors, including alert burden and diagnostic performance, was limited.

Conclusions:

Economic evidence on algorithm-enabled CIED remote monitoring suggests potential value in some settings, but the evidence remains methodologically heterogeneous and difficult to compare directly across studies. Findings are sensitive to differences in intervention design, modelling approaches, and clinical input data, which limit certainty and transferability. More robust and standardised evidence is needed before economic conclusions can be applied confidently across different devices, algorithms, and healthcare settings.