Cost‐Effectiveness of Remote Cardiac Monitoring With theCardioMEMSHeart Failure System

Abstract

Heart failure (HF) is a leading cause of cardiovascular mortality in the United States and presents a substantial economic burden. A recently approved implantable wireless pulmonary artery pressure remote monitor, the CardioMEMS HF System, has been shown to be effective in reducing hospitalizations among New York Heart Association (NYHA) class III HF patients. The objective of this study was to estimate the cost‐effectiveness of this remote monitoring technology compared to standard of care treatment for HF. A Markov cohort model relying on the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) clinical trial for mortality and hospitalization data, published sources for cost data, and a mix of CHAMPION data and published sources for utility data, was developed. The model compares outcomes over 5 years for implanted vs standard of care patients, allowing patients to accrue costs and utilities while they remain alive. Sensitivity analyses explored uncertainty in input parameters. The CardioMEMS HF System was found to be cost‐effective, with an incremental cost‐effectiveness ratio of $44,832 per quality‐adjusted life year (QALY). Sensitivity analysis found the model was sensitive to the device cost and to whether mortality benefits were sustained, although there were no scenarios in which the cost/QALY exceeded $100,000. Compared with standard of care, the CardioMEMS HF System was cost‐effective when leveraging trial data to populate the model.

Wedged Sensor in Distress? Lessons Learned from Troubleshooting Dampened Transmitted PA Waveforms of CardioMEMS Device

“…The recent CardioMEMS postapproval study showed an even greater decrease of 58% in heart failure hospitalizations at 1-year postimplantation [8] while a recent single-center study showed nearly an 80% reduction in heart failure admission and an almost 70% reduction in overall admissions [9]. Consequently, CardioMEMS has become an economically efficient technology, with the cost of device implantation being under $20,000 [1]. In contrast, using the 5-year observational period following the CHAMPION trial, heart failure treatment costs total nearly $170,000 which include future hospitalizations, monthly monitoring, and routine care and "… all costs are weighted based on the assumption that 75% of patients are covered by Medicare and 25% have commercial coverage" [1].…”

“…Consequently, CardioMEMS has become an economically efficient technology, with the cost of device implantation being under $20,000 [1]. In contrast, using the 5-year observational period following the CHAMPION trial, heart failure treatment costs total nearly $170,000 which include future hospitalizations, monthly monitoring, and routine care and "… all costs are weighted based on the assumption that 75% of patients are covered by Medicare and 25% have commercial coverage" [1]. As the technology becomes more widespread, it is important for providers to be aware of the adverse events associated with the device.…”

“…Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide and in the US and encompasses a wide variety of diseases. Heart failure constitutes a large portion of this spectrum with close to 6 million adults affected in the US [1]. That number is expected to increase over the next 15 years with CVD-related costs projected to reach up to $1.1 trillion, a large portion of which can be attributed to heart failure (HF) rehospitalizations [2].…”

CardioMEMS in a Busy Cardiology Practice: Less than Optimal Implementation of a Valuable Tool to Reduce Heart Failure Readmissions

“…The CHAMPION trial showed not only an improvement in the quality of life but also a reduction in heart failure hospital admissions and a decreased length of admission [ 3 ]. Furthermore, there was a $7,433 six-month comprehensive heart failure cost reduction associated with the lower rate of hospitalizations [ 16 ], and the remote pulmonary artery pressure-monitoring device was also noted to have a cost-effectiveness ratio of $44,832 per quality-adjusted life year [ 17 ].…”

Impact of CardioMEMS device placement on lifestyle modifications: a “pseudo-placebo” effect beyond the expected?

“… 7 In another study, the CardioMEMS device was found to have a cost-effectiveness ratio of $44,832 per quality-adjusted life year. 8 Elevated diastolic PA pressure is associated with a high risk of hospitalization and mortality, and patients with implantable hemodynamic technology were found to have lower PA pressures. 9 In this study, we sought to identify potential lifestyle changes of patients with CardioMEMS device placement and whether such a technologically advanced device is easy to use for patients.…”