Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis

Abstract

Background The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Conclusions Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.

Cost-Effectiveness of Mobile Health–Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis

“…To our best knowledge, no cost-effectiveness analysis has previously been performed to examine the application of mHealth technology in care after an AF diagnosis, although such an analysis has been performed for screening [ 34 ]. Our findings are in line with the results of previous cost-effectiveness analyses investigating mHealth tools for other cardiovascular diseases, indicating the cost-effective use of the mHealth support system [ 16 - 18 ]. The small improvement in QALYs by the mHealth-based care for AF, similar to other digital health technologies, may be driven by a small, estimated gain in survival and reflect the indirect effects of the technologies on mortality.…”

“…In this study, 1261 subjects who received mHealth technology–supported care were followed up over 1 year and had a lower risk of composite outcomes of “ischemic stroke (IS)/systemic thromboembolism, death, and rehospitalization” compared with that of their counterparts receiving usual care. mHealth-based care has been demonstrated to be cost-effective in managing diabetes, hypertension, and heart failure; however, the health economic impact of mHealth for patients with AF remains unknown [ 16 - 18 ].…”

Through and Beyond Covid-19 Pandemic: A New Scenario for Cardioncology

“…The spread of telemonitoring employing mobile phones allows us remote control of useful parameters such as oxygen saturation, blood pressure, ECG, glycemic values in diabetics. Since the beginning of the COVID-19 pandemic, several initiatives have been launched on the use of telemedicine to check and control atrial fibrillation (18), diabetes (19), hypertension (20), and heart failure (21)(22)(23), clinical conditions common also in the cardioncology practice. Preliminary clinical experience suggests the technological improvement may support also the synchronous telerehabilitation programs (24).…”

Enhancing Home Monitoring of Patients With Heart Failure: Primary Care Experience With an Autonomous Foot-Measuring Device

“…14 Many countries, particularly in Europe, have incorporated these platforms into their clinical practice for heart failure management, resulting in encouraging outcomes. [13][14][15][16] Currently, a variety of TM systems are either in use or under development. 11 Some of the most prominent and promising devices include CardioMEMS Heart Failure System, HeartPOD (Abbott), HeartLogic (Boston Scientific), V-LAP (Vectorious Medical Technologies), Medtronic OptiVol Fluid Status Monitoring and CareLink Network (OptiLink Heart Failure), and Chronicle IHM (Medtronic).…”

“…11 Some of the most prominent and promising devices include CardioMEMS Heart Failure System, HeartPOD (Abbott), HeartLogic (Boston Scientific), V-LAP (Vectorious Medical Technologies), Medtronic OptiVol Fluid Status Monitoring and CareLink Network (OptiLink Heart Failure), and Chronicle IHM (Medtronic). [14][15][16][17][18][19][20] However, many of these TM technologies are invasive and require patient adherence, typically for the transfer of patientinitiated sensor data to an internet-connected device. 17 Previous studies have reported high adherence rates, but it should be noted that these studies typically exclude patients who are non-adherent with TM or disinclined to participate due to onerous trial protocols.…”