A telemonitoring programme in patients with heart failure in France: a cost-utility analysis

Abstract

Background Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. Methods A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. Results The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. Conclusions Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review

“…After a full-text screening of the remaining 62 studies, we excluded 37 (60%; 21/37, 57% were classified as partial economic evaluations, such as cost analysis, containing only descriptions of costs; 10/37, 27% did not report outcomes specifically for HF; and 6/37, 16% were conference abstracts), resulting in 25 (40%) out of 62 studies for inclusion in the analysis. Two extra studies were identified from reference reviews; thus, 27 studies [ 31 - 57 ] were included in this systematic review.…”

“…Table 1 summarizes the general characteristics of the included studies. Of the 27 studies, 13 (48%) were conducted using a decision analytical model [ 31 - 35 , 40 , 47 - 51 ], 13 (48%) used trial-based data [ 36 - 39 , 41 - 46 , 54 - 57 ], and 1 (4%) used a combination of both [ 41 ]. The majority of the studies (25/27, 93%) were from HICs.…”

“…The majority of the studies (25/27, 93%) were from HICs. Of the 27 studies, 6 (22%) were from the United States [ 34 , 43 , 44 , 51 - 53 ]; 3 (11%) each from the Netherlands [ 33 , 37 , 40 ] and the United Kingdom [ 32 , 35 , 50 ]; 2 (7%) each from Germany [ 36 , 38 ], Brazil [ 41 , 45 ], Canada [ 42 , 48 ], Italy [ 55 , 56 ], and Spain [ 46 , 49 ]; and 1 (4%) each from Australia [ 57 ], Poland [ 54 ], France [ 31 ], Hong Kong [ 47 ], and Denmark [ 39 ]. Of the 27 studies, 24 (89%) conducted a cost-utility analysis with cost and QALY as the outcome measures [ 31 - 35 , 37 - 40 , 42 - 51 , 54 , 56 , 57 ], 2 (7%) conducted a cost-effectiveness analysis (1/2, 50% with hospital readmission as the outcome measure [ 41 ] and 1/2, 50% with number of days alive and neither in hospital nor in inpatient care as the outcome measure [ 36 ]), and 1 (3%) conducted a cost-minimization analysis [ 55 ].…”

“…Of the 27 studies, 15 (56%) used a time horizon of >1 year (3/15, 20% were RCTs) [ 31 - 35 , 40 , 44 , 45 , 47 , 48 , 50 - 54 ]; the time horizon in 6 (22%) studies was ≤1 year (all were RCTs) [ 36 , 39 , 41 - 43 , 46 ]; 6 (22%) did not state the time horizon (5/6, 83% were RCTs and 1/6, 17% was model based) [ 37 , 38 , 49 , 55 - 57 ]. Of the 27 studies, 15 (56%) received grants from public organizations [ 31 , 32 , 35 , 36 , 38 - 41 , 43 , 44 , 46 , 49 , 54 , 56 , 57 ], 3 (11%) received funding from industry [ 37 , 50 , 51 ], 2 (7%) received no funding [ 42 , 55 ], and 7 (26%) did not declare their funding source [ 33 , 34 , 45 , 47 , 48 , 52 , 53 ].…”

The role of telemedicine towards improved sustainability in health care and societal productivity in Turkey

“…Secondly, the cost-effective interventions could be unaffordable [46]. The cost-effective benefit may not be achieved if the implementation (internet infrastructure, servers, end-user devices and applications) is prohibitively expensive [47]- [49]. In addition, the few programs that start successfully may not always be sustainable in the long run, scalable, or transferable to other settings [50].…”