JMIR Publications

ABSTRACT

Background:

Telemonitoring of cardiac implantable electronic devices (CIEDs) can improve patient management. However, results of cost-effectiveness studies are heterogeneous.

Objective:

This systematic review investigated the cost-effectiveness of telemonitoring CIED patients with a special focus on its key drivers, and the impact of the varying perspectives

Methods:

A systematic review was performed in MEDLINE, Web of Science, EMBASE, and EconLit. Papers were included if they fulfilled following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations. No year limits were applied. Quality was assessed using the Consensus Health Economic Criteria checklist.

Results:

Fifteen cost-effectiveness analyses were included. Eleven studies indicated that telemonitoring patients with implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy ICDs (CRT-D) was cost-effective and cost-saving, both from healthcare and patient perspective. Cost-effectiveness results for telemonitoring pacemakers were inconclusive. Key drivers for cost reduction per perspective were: (a) healthcare: hospitalization costs; (b) patient: loss of income, cost for scheduled in-office visits, and transport costs; (c) provider: drivers for income reduction were scheduled in-office visits. Finally, eight studies reported an increase in quality of life, which was only statistically significant in one study.

Conclusions:

From a healthcare and patient perspective, telemonitoring of ICD/CRT-D patients is a cost-effective and cost-saving alternative to standard care. Inconclusive results are found for pacemaker patients. However, telemonitoring can lead to a decrease in providers’ income mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers, while still be cost-effective from a healthcare payer perspective.