JMIR Publications

ABSTRACT

Background:

Patient self-monitoring of vital parameters and lifestyle factors may improve cardiovascular risk management in primary care. However, large-scale adoption remains limited, partly due to insufficient economic and workload-related evidence for decision-makers.

Objective:

We estimated the long-term cost-effectiveness, budget impact, and reductions in healthcare professional workload associated with the CVRM-Box intervention in the Netherlands. CVRM-Box is a multicomponent remote patient management (RPM) intervention utilizing a digital blood pressure monitor, weight scale, step counter, and a mobile app with data linkage to the GP practice.

Methods:

Using a time-inhomogeneous Markov model, we assessed the lifetime health and economic impact of CVRM-Box versus care as usual (CaU), including subgroup analyses. Model parameters incorporated data from a recent matched cohort study of CVRM-Box, routine primary care records, academic literature, and established risk models (i.e., SCORE2 and SMART2). Incremental cost-effectiveness ratios (ICERs) indicating costs per additional quality-adjusted life year (QALY) gained, five-year budget impact, and workload reductions for general practitioners (GPs) and practice nurses (PNs) were estimated. Extensive uncertainty analyses were performed.

Results:

The overall ICER for CVRM-Box vs. CaU was €17,340/QALY gained. The probability of cost-effectiveness in the three highest risk subgroups was ≥70% at a willingness to pay of €20,000/QALY. The five-year budget impact was €2.9 million and €662.2 million assuming regional and national rollout respectively. The intervention resulted in annual workload reductions in visits and e-consultations with GPs and PNs.

Conclusions:

The CVRM-Box multicomponent RPM intervention is highly likely to be cost-effective in high-risk groups and reduces workload for GPs and PNs. Implementation in general practice is recommended while considering regional and subgroup-specific factors.