Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jan 16, 2020
Open Peer Review Period: Jan 16, 2020 - Feb 20, 2020
Date Accepted: Feb 29, 2020
Date Submitted to PubMed: May 15, 2020
(closed for review but you can still tweet)
Telemonitoring versus usual care for elderly patients with hospital discharge for heart failure in US: A cost-effectiveness analysis
ABSTRACT
Background:
Telemonitoring (TM)-guided interventional management reduces hospitalization and mortality of patients with chronic heart failure (CHF).
Objective:
To analyze the cost-effectiveness of usual care (UC) with and without TM-guided management in patients discharged for CHF from the perspective of US healthcare providers.
Methods:
A life-long Markov model was designed to estimate outcomes of (1) UC alone for all post-discharged CHF patients (New York Heart Association (NYHA) class I-IV), (2) UC plus TM for all post-discharged CHF patients, (3) UC for all post-discharged CHF patients plus TM for patients with NYHA class III-IV; (4) UC for all post-discharged CHF patients plus TM for patients with NYHA class II-IV. Model inputs were derived from literature and public data. Sensitivity analyses were conducted to assess robustness of model results. Primary outcomes were total direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER).
Results:
In base-case analysis, universal TM group gained highest QALYs (6.2967 QALYs), followed by TM for NYHA class II-IV group (6.2960 QALYs), TM for NYHA class III-IV group (6.2450 QALYs), and UC alone (6.1530 QALYs). ICERs of TM for NYHA class III-IV (35,393 USD/QALY) and TM for NYHA class II-IV groups (38,261 USD/QALY) were lower than the ICER of universal TM group (100,458 USD/QALY). In probabilistic sensitivity analysis, probabilities of universal TM, TM for NYHA class II-IV, TM for NYHA class III-IV, and universal UC to be accepted as cost-effective at USD50,000/QALY were 2.76%, 76.31%, 18.6%, and 2.33%, respectively.
Conclusions:
UC for all discharged CHF patients plus TM-guided management for NYHA class II-IV patients appears to be the preferred cost-effective strategy.
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