Cost–utility analysis of remote versus conventional monitoring of pacemakers in the Arctic Circle

Abstract Introduction Several studies have demonstrated that remote monitoring (RM) of pacemakers is safe, effective and cost-saving. The aim of this study was to perform an economic assessment and check whether RM offers a cost-utility alternative to conventional monitoring in hospital (CM). Methods This is a controlled, randomized, non-masked clinical trial. Fifty patients with pacemaker were assigned to receive either RM (n = 25) or CM (n = 25). Data were collected during the 12 months. A cost-utility analysis was performed in order to assess whether RM of pacemakers is cost-effective compared to CM in hospital in terms of costs per gained quality-adjusted life years (QALY). The analysis was performed from the perspectives of the Norwegian Healthcare System (NHS) and patients. Results Overall, total costs from the NHS perspective were higher in the RM group (€2,079.84 vs. €271.97; p = 0.147). The costs related to the patients perspective were higher in the RM than those in the CM group (€223.99 vs. €158.42, respectively; P = 0.429). Patients included in the CM obtained 0.04 QALYs less than those in the RM group over 12 months and the total costs per QALY comprised €1,784.10 (P = 0.175) per user with a pacemaker implant. The total number of pacemaker transmissions per patient year comprised 86.46% of minors in the CM group. Conclusions The follow-up costs were similar between both groups. Cost-utility analysis showed broad confidence intervals with ICERs ranging from potential savings to high costs for an additional QALY, with most ICERs lower than the usual NHS thresholds for coverage decisions. Key messages Total costs from the National Health System perspective were higher in the remote monitoring group, although there were not significant differences between both groups of follow-up. The costs related to the patient perspective were higher in the remote monitoring than those in the conventional monitoring group, without significant differences.

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Long-term cost-utility analysis of remote monitoring of older patients with pacemakers: the PONIENTE study

BMC Geriatrics ◽

10.1186/s12877-020-01883-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rafael Jesus Bautista-Mesa ◽

Antonio Lopez-Villegas ◽

Salvador Peiro ◽

Daniel Catalan-Matamoros ◽

Emilio Robles-Musso ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Remote Monitoring ◽

Older Patients ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Life Years

Abstract Background Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of older patients with pacemakers, 5 years after implant. Methods Under a controlled, not randomized, nor masked clinical trial, 83 patients with pacemakers were initially selected. After five years of follow-up, a total of 55 patients (CM = 34; RM = 21) completed the study. A cost-utility analysis of RM in terms of costs per gained quality-adjusted life years (QALYs) was conducted. The costs from the Public Health System (PHS) as well as patients and their relatives were taken into account for the study. The robustness of the results was verified by the probabilistic analyses through Monte-Carlo simulations. Results After a five-year follow-up period, total costs were lower in the RM group by 23.02% than in the CM group (€274.52 versus €356.62; p = 0.033) because of a cost saving from patients’ perspective (€59.05 versus €102.98; p = 0.002). However, the reduction of in-hospital visits derived from RM exhibited insignificant impact on the costs from the PHS perspective, with a cost saving of 15.04% (€215.48 vs. €253.64; p = 0.144). Costs/QALYs obtained by the RM group were higher as compared to the CM group, although there were no significant differences. The incremental cost-effectiveness ratio of CM in comparison to RM became positive (€301.16). Conclusions This study confirms RM of older patients with pacemakers appears still as a cost-utility alternative to CM in hospital after 5 years of follow-up. Trial registration ClinicalTrials.gov: (Identifier: NCT02234245). Registered 09 September 2014 - Prospectively registered.

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Cost-Utility Analysis of Total Hip Arthroplasties: Technology Assessment of Surgical Procedures by Mailed Questionnaires

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300012046 ◽

1998 ◽

Vol 14 (4) ◽

pp. 735-742 ◽

Cited By ~ 13

Author(s):

Uri Givon ◽

Gary M. Ginsberg ◽

Henri Horoszowski ◽

Joshua Shemer

Keyword(s):

Cost Utility ◽

Cost Utility Analysis ◽

Quality Adjusted Life Years ◽

Utility Analysis ◽

Total Hip ◽

Cementless Implant ◽

Life Years ◽

Hip Arthroplasties ◽

Quality Adjusted Life

AbstractA retrospective study comparing 700 consecutive total hip arthroplasties, utilizing four types of implants, was performed. Questionnaires based on hip scores were sent to 593 living patients. Useful responses were received from 363 (61 %) patients. Hip scores and quality-adjusted life-years were calculated. Multiple regression analysis, controlling for all possible biases, demonstrated one cementless implant as superior to all others. We believe that the use of mailed questionnaires is a simple and convenient system of follow-up, saving patients the need for outpatient clinic visits. The validity of such replies, however, has yet to be established.

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Cost-utility analysis of remote monitoring of users with pacemakers five years after implantation

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.568 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Lopez-Villegas ◽

R Bautista-Mesa ◽

S Peiro ◽

D Catalan-Matamoros ◽

E Robles-Musso ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Remote Monitoring ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Life Years ◽

Hospital Visits ◽

Effectiveness Studies

Abstract Introduction Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of patients with pacemakers, 5 years after implant. Methods Under a controlled, not randomized nor masked clinical trial, 82 patients with pacemaker were initially selected (CM = 52; RM = 30). Patients were monitored during 5 years, after what a total 34 for CM in hospital and 21 for RM finalised the study. A cost-utility analysis was conducted to assess cost-utility of RM in terms of costs per gained quality-adjusted life years (QALYs). Costs from National Health Service (NHS) and patient perspectives were considered. Results After 60-months of follow-up, total costs per patient were 23.02% lower in the RM than in the CM group, corresponding to a €82.10 cost saving per patient (p = 0.033). However, the reduction of in-hospital visits derived from RM does not impact significantly costs from the NHS perspective, with a cost saving of 15.04% per patient (p = 0.144). Patients in the CM group showed a slightly better QALY at the end of the study (3.579) than RM group (3.306). Costs/QALYs obtained by the RM group were higher than the CM group (p = 0.773). The incremental cost-effectiveness ratio of CM in comparison to RM becomes positive (€301.16). Conclusions This study confirms RM of patients with pacemakers appears still as a cost-effective alternative to conventional monitoring in hospital after 5 years. Key messages Total costs per patient were 23.02% lower in the Remote Monitoring than in the Conventional Monitoring group (p = 0.033). The reduction of in-hospital visits derived from Remote Monitoring does not impact significantly costs from the NHS perspective, with a cost saving of 15.04% per patient (p = 0.144).

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Cost-utility analysis on telemonitoring of users with pacemakers: The PONIENTE study

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18767184 ◽

2018 ◽

Vol 25 (4) ◽

pp. 204-212 ◽

Cited By ~ 4

Author(s):

Antonio Lopez-Villegas ◽

Daniel Catalan-Matamoros ◽

Emilio Robles-Musso ◽

Rafael Bautista-Mesa ◽

Salvador Peiro

Keyword(s):

Cost Saving ◽

Cost Effective ◽

Economic Assessment ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Significant Cost ◽

Life Years ◽

The Cost

Introduction Few studies have confirmed the cost-saving of telemonitoring of users with pacemakers (PMs). The purpose of this controlled, non-randomised, non-masked clinical trial was to perform an economic assessment of telemonitoring (TM) of users with PMs and check whether TM offers a cost-utility alternative to conventional follow-up in hospital. Methods Eighty-two patients implanted with an internet-based transmission PM were selected to receive either conventional follow-up in hospital ( n = 52) or TM ( n = 30) from their homes. The data were collected during 12 months while patients were being monitored. The economic assessment of the PONIENTE study was performed as per the perspectives of National Health Service (NHS) and patients. A cost-utility analysis was conducted to measure whether the TM of patients with PMs is cost-effective in terms of costs per gained quality-adjusted life years (QALYs). Results There was a significant cost-saving for participants in the TM group in comparison with the participants in the conventional follow-up group. From the NHS’s perspective, the patients in the TM group gained 0.09 QALYs more than the patients in the conventional follow-up group over 12 months, with a cost saving of 57.64% (€46.51 versus €109.79, respectively; p < 0.001) per participant per year. In-office visits were reduced by 52.49% in the TM group. The costs related to the patient perspective were lower in the TM group than in the conventional follow-up group (€31.82 versus €73.48, respectively; p < 0.005). The costs per QALY were 61.68% higher in the in-office monitoring group. Discussion The cost-utility analysis performed in the PONIENTE study showed that the TM of users with PMs appears to be a significant cost-effective alternative to conventional follow-up in hospital.

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