A Remote Patient Monitoring Intervention for Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Pre-Post Economic Analysis of the Smart Program

Abstract

BackgroundExacerbation of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are associated with high health care costs owing to increased emergency room (ER) visits and hospitalizations. Remote patient monitoring (RPM) interventions aim to improve the monitoring of symptoms to detect early deterioration and provide self-management strategies. As a result, RPM aims to reduce health resource utilization. To date, studies have inconsistently reported the benefits of RPM in chronic illnesses. The Smart Program is an RPM intervention that aims to provide clinical benefit to patients and economic benefit to health care payers.ObjectiveThis study aims to economically evaluate the potential benefits of the Smart Program in terms of hospitalizations and ER visits and, thus, associated health care costs from the perspective of the public health care system.MethodsSeventy-four patients diagnosed with COPD or CHF from one hospital site were included in this one-group, pre-post study. The study involved a secondary data analysis of deidentified data collected during the study period – from 3 months before program initiation (baseline), during the program, to 3 months after program completion (follow-up). Descriptive analysis was conducted for the study population characteristics at baseline, the clinical frailty score at baseline and 3-month follow-up, client satisfaction at 3-month follow-up, and number and costs of ER visits and hospitalizations throughout the study period. Furthermore, the cost of the Smart Program over a 3-month period was calculated from the perspective of the potential implementer.ResultsThe baseline characteristics of the study population (N=74) showed that the majority of patients had COPD (50/74, 68%), were female (42/74, 57%), and had an average age of 72 (SD 12) years. Using the Wilcoxon signed-rank test, the number of ER visits and hospitalizations, including their associated costs, were significantly reduced between baseline and 3-month follow-up (P<.001). The intervention showed a potential 68% and 35% reduction in ER visits and hospitalizations, respectively, between the 3-month pre- and 3-month postintervention period. The average cost of ER visits reduced from Can $243 at baseline to Can $67 during the 3-month follow-up, and reduced from Can $3842 to Can $1399 for hospitalizations.ConclusionsIn this study, the number and cost of ER visits and hospitalizations appeared to be markedly reduced for patients with COPD or CHF when comparing data before and after the Smart Program implementation. Recognizing the limitations of the one-group, pre-post study design, RPM requires an upfront investment, but it has the potential to reduce health care costs to the system over time. This study represents another piece of evidence to support the potential value of RPM among patients with COPD or CHF.

Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial

“…However, Vestergaard et al [ 12 ] found that the Danish TeleCare North HF trial led to cost savings and was cost-effective in terms of health-related quality of life in favour of the intervention. Isaran et al [ 13 ] studied remote patient monitoring in HF and chronic obstructive pulmonary disease (COPD), and found that the cost of emergency room visits and hospitalizations were reduced. For Germany, the CardioBBEAT trial investigated the cost-effectiveness of noninvasive telemonitoring as a primary endpoint.…”

Mobile App–Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis

“…In a previous study evaluating the use of an RPM solution in the care of exacerbation of COPD and chronic heart failure, Isaranuwatchai et al [ 8 ] studied the economic impact of remote monitoring symptoms to detect early deterioration of patient health. It is, therefore, somewhat suited to an evaluation in the context of monitoring of acute conditions.…”

“…This study showed a potential reduction of 68% and 35% in the number of emergency room (ER) visits and hospitalizations, respectively, between the 3-month pre– and post–RPM intervention periods. The average ER visit cost was reduced from CA $243 (~US $191) at the baseline to CA $67 (~US $53) during the 3-month follow-up and from CA $3842 (~US $3023) to CA $1399 (~US $1100) for hospitalization [ 8 ]. This result demonstrates that an RPM solution can not only free-up resources but also lead to a less resource-heavy and, therefore, less-expensive visit or admission in the context of acute care.…”

Aligning mission to digital health strategy in academic medical centers

“…In the pre-COVID-19 period, clinical adoption was primarily driven by financially incentivizing models. Traditional telemedicine, for example, potentially reduced the use of high-cost in-person resources, and hospital admissions and readmissions for populations with heart failure and chronic obstructive pulmonary disease 12 – 15 . Such savings were relevant with capitated payer models, while real-world savings in fee-for-service settings have been less clear and are being investigated 16 .…”