JMIR Publications

ABSTRACT

Background:

Heart failure (HF) is a major public health issue in Canada associated with a high prevalence, morbidity, mortality, as well as 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 HF patients that has been found to improve patient outcomes. However, the cost-effectivness of the Medly program has yet to be determined.

Objective:

To conduct a cost-utility analysis of the Medly program compared to the standard of care for HF from a public payer perspective.

Methods:

Using a microsimulation model, individual patient datawere simulated over a 25-year time horizon to compare the costs and 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 as well as probalistic 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 $102,508 per patient and total QALYs of 5.51 per patient compared to $97,497 and 4.95 QALYs in the standard care group. This led to an incremental cost of $5,011 and incremental QALY of 0.566 resulting in an ICER of $8,850/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models where patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness >85% at a willingness-to-pay threshold of $50,000. While 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 to standard care. 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.