EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring

Abstract

AimRemote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits in combination with earlier detection of relevant findings. Its implementation requires investment and reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The primary end-point of this randomized prospective multicentre health economic trial was the total FU-related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU (HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers (taking national reimbursement into account) and costs from a healthcare payer perspective were evaluated.Methods and resultsA total of 312 patients with VVI- or DDD-ICD implants from 17 centres in six EU countries were randomised to HM ON or OFF, of which 303 were eligible for data analysis. For all contacts (in-office, calendar- or alert-triggered web-based review, discussions, calls) time-expenditure was tracked. Country-specific cost parameters were used to convert resource use into monetary values. Remote FU equipment itself was not included in the cost calculations. Given only two patients from Finland (one in each group) a monetary valuation analysis was not performed for Finland. Average age was 62.4 ± 13.1 years, 81% were male, 39% received a DDD system, and 51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 ± 1.67 vs. 5.53 ± 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 ± 1.50 vs. 0.62 ± 1.25; P < 0.005), more non-office-based contacts (1.95 ± 3.29 vs. 1.01 ± 2.64; P < 0.001), more Internet sessions (11.02 ± 15.28 vs. 0.06 ± 0.31; P < 0.001) and more in-clinic discussions (1.84 ± 4.20 vs. 1.28 ± 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 ± 1.18 vs. 0.85 ± 1.43, P = 0.23) and shorter length-of-stay (6.31 ± 15.5 vs. 8.26 ± 18.6; P = 0.27), although not significant. For the whole study population, the total FU cost for providers was not different for HM ON vs. OFF [mean (95% CI): €204 (169–238) vs. €213 (182–243); range for difference (€−36 to 54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient (including other physician visits, examinations, and hospitalizations) was numerically (but not significantly) lower. There was no difference in the net financial impact on providers [profit of €408 (327–489) vs. €400 (345–455); range for difference (€−104 to 88), NS], but there was heterogeneity among countries, with less profit for providers in the absence of specific remote FU reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases where such reimbursement exists (Germany and UK). Quality of life (SF-36) was not different.ConclusionFor all the patients as a whole, FU-related costs for providers are not different for remote FU vs. purely in-office FU, despite reorganized care. However, disparity in the impact on provider budget among dif...

The impact of remote monitoring of implanted cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy device (CRT-D) patients on healthcare costs in the Silesian population: three-year follow-up

“…In the EuroEco trial there was no difference in the net financial impact on providers (profit of 408 Euro vs. 400 Euro [345-455]; range for difference [2104 to 88 Euro], NS), but there was heterogeneity among countries. Less profit was noted for providers in the absence of specific remote follow-up reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases where such reimbursement exists (Germany and the United Kingdom) [10]. In our study, despite no reimbursement for RM, a significant reduction in costs was shown.…”

“…Similarly to other previous reports, fewer hospitalisations (0.67 ± 1.18 vs. 0.85 ± 1.43, p = 0.23) and shorter length of stay were noted, although they were not significant. Finally, for the whole study population, the total follow-up cost for providers was no differ- [10]. The total decrease in costs from a payer's perspective over a two-year period was too small to be considered statistically significant.…”

Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services

“…19 In Europe, costs for implantable cardiac defibrillator remote follow-up visits were found to be essentially the same as those for in-office follow-up visits. 20 A few studies provide information about the knowledge, attitudes, and adoption of telehealth services among health care providers. A systematic review of articles published through February 2013 investigating the perceptions of primary care clinicians, administrators, and clinical staff regarding the acceptability and feasibility of remote monitoring technology in routine adult primary care found only 15 studies meeting inclusion criteria.…”

Wpływ kardiowertera-defibrylatora na jakość życia — przegląd badań

“…Różnice te zacierały się w 12. miesiącu obserwacji [63]. Z kolei wyniki badania EuroEco u 312 pacjentów nie dowiodły istotnego wpływu na QoL dwóch opisanych wyżej strategii opieki nad chorymi z ICD w czasie 2-letniej obserwacji (zdalna kontrola ICD v. rutynowa opieka) [64].…”