Potential Cost Savings by Telemedicine‐Assisted Long‐Term Care of Implantable Cardioverter Defibrillator Recipients

Abstract

Home monitoring (HM) of cardioverter defibrillators (ICD) with its automated wireless remote data access, may decrease the rate of patient visits. This study examined the potential cost savings for the long-term care of ICD assisted by HM. A French database including 502 patients from 6 university hospitals was used. Costs of conventional follow-up (FU) of ICD were calculated without, and compared with the expected cost of FU with HM. Calculations included number of visits, including physician's fees, electrocardiograms, and specific ICD surveillance, and transportation costs. The mean distance between home and institutions performing follow-ups was 69 +/- 57 km. For each visit, a mean overall cost of 215 dollars was calculated, including 121 dollars for transportation and 94 dollars for medical services. HM may obviate up to 2 visits per year. Over the 5 years of expected life of the device, the decrease in costs for FU visits was estimated at 2,149 dollars. With an additional cost of 1,200 dollars for the HM system, saving began after a mean FU of 33.5 months. The time to onset of cost saving by HM ranged between 17.4 months for patients living >150 km from the medical facility to 52.2 months for those living <50 km away. It is concluded that the HM may considerably reduce the overall costs of ICD FU by saving on transportation cost, particularly when the distance between home and medical facility is >100 km.

Remote Monitoring Reduces Healthcare Use and Improves Quality of Care in Heart Failure Patients With Implantable Defibrillators

“…14,17 Our study design allowed total office evaluations to be reduced, although the proposed reduction in scheduled in-person encounters was less drastic than in other experiences. Indeed, in previous randomized trials, 18,19 regular 3-month visits were replaced with transmissions, and ICD patients underwent in-office evaluation every 12 or 14 months.…”

Economic impact of remote monitoring on ordinary follow-up of implantable cardioverter defibrillators as compared with conventional in-hospital visits. A single-center prospective and randomized study

“…Fauchier et al [12], in a retrospective analysis of 502 patients with remotely monitored ICDs, found that RM reduced the social costs of ICD follow-up by as much as USD 2,149 over the 5 years of expected life of the device. This study included the costs of transportation and medical services, but did not consider the cost of lost employment income for the time spent on in-hospital visits for patients and accompanying persons.…”

“…Most common reasons for unscheduled in-hospital or remote follow-ups were as follows: in the RM group, remote alerts for atrial or ventricular arrhythmia episodes [17], appropriate or inappropriate ICD therapy deliveries including anti-tachycardia pacing [12], out-of-range lead (pacing or shock) impedance [10], alerts for parameter values possibly related with a worsening heart failure [6], and other non-device-related causes [7]; in the control group, appropriate or inappropriate ICD shock deliveries [11], symptoms related with worsening heart failure [4] or atrial and ventricular arrhythmias not associated with ICD therapies [7], and other reasons [3]. All the unscheduled in-hospital visits in the RM group were triggered by RM alerts.…”

“…information can enable physicians to rapidly identify patients requiring attention for device-related or clinical problems [7][8][9][10][11]. However, up to the present, few studies have evaluated the economic impact of remote ICD management compared with conventional periodic in-hospital follow-up [12][13][14][15].…”

Monitorização à distância no seguimento de portadores de dispositivos cardíacos implantados

“…Uma meta-análise baseada na avaliação de hospitalizações e custos numa população com insuficiência cardíaca desenvolvido na Alemanha, concluiu que os gastos hospitalares associados ao follow-up de doentes com dispositivos cardíacos se reduziam em cerca de 60% na modalidade de monitorização à distância 29 . Em termos de custos, a utilização da monitorização à distância tem a capacidade de reduzir os gastos totais do seguimento em doentes com dispositivos cardíacos implantados com benefício na relação custo-efetividade 11 .…”