Cost-effectiveness of a telemonitoring program in patients with cardiovascular diseases compared to standard of care

Abstract

ObjectivesThe main aim of this work was to analyze the cost-effectiveness of an integrated care concept (NICC) that combines telemonitoring with the support of a care center in addition to guideline therapy for patients. Secondary aims were to compare health utility and health-related quality of life (QoL) between NICC and standard of care (SoC).MethodsThe randomized controlled CardioCare MV trial compared NICC and SoC in patients from Mecklenburg-West Pomerania (Germany) with atrial fibrillation, heart failure, or treatment-resistant hypertension. QoL was measured using the EQ-5D-5L at baseline, 6 months, and 1 year follow-up. Quality-adjusted life-years (QALY), EQ5D utility scores, visual analogue scale (VAS) scores, and VAS adjusted life-years (VAS-AL) were calculated. Cost data were obtained from health insurance companies, and the payer perspective was taken in health economic analyses. Quantile regression was used with adjustments for stratification variables.ResultsThe net benefit of NICC (QALY) was 0.031 (95%CI: 0.012–0.050; p=0.001) in this trial involving 957 patients. EQ5D index values, VAS-ALs and VAS were larger for NICC compared to SoC at 1 year follow-up (all p≤0.004). Direct cost per patient and year were €323 (CI: €157–489) lower in the NICC group. When 2000 patients are served by the care center, NICC is cost-effective if one is willing to pay 10,652€ per QALY per year.ConclusionNICC was associated with higher QoL and health utility. The program is cost-effective if one is willing to pay approximately 11,000€ per QALY per year.WHAT IS ALREADY KNOWN ON THIS TOPICIntegrated care concepts, i.e., the combination of telemedicine and the reinforcement of patient self-care in a multidisciplinary team together with telephone support, reduce mortality, morbidity, and levels of depression in patients with cardiovascular diseases.WHAT THIS STUDY ADDSThe integrated care concept investigated in the CardioCare MV trial was also associated with higher quality of life, higher health utility, and it is cost-effective if one is willing to pay approximately 11,000 € per quality-adjusted life-year (QALY).HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYWith the demonstrated cost effectiveness of the integrated care concept, policy makers and health insurance companies are enabled to decide on the introduction of these concepts as standard of care.