A Telemonitoring Programme in Patients with Heart Failure in France: A Cost-Utility Analysis

Abstract Background Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the longest-running and largest telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. Methods A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state. The model lifetime in the base case was ten years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. Results The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the ten-year lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4,245. The incremental cost-effectiveness ratio for the SCAD programme over standard care was estimated at €4,579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. Conclusions Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

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Evaluation of a Heart Failure Telemonitoring Program Through a Microsimnulation Model: Cost-Utility Analysis (Preprint)

10.2196/preprints.18917 ◽

2020 ◽

Author(s):

Chris Boodoo ◽

Qi Zhang ◽

Heather J Ross ◽

Ana Carolina Alba ◽

Audrey Laporte ◽

...

Keyword(s):

Public Health ◽

Heart Failure ◽

Cost Effectiveness ◽

Standard Care ◽

Cost Effective ◽

Standard Of Care ◽

Cost Utility ◽

Cost Utility Analysis ◽

Model Parameters ◽

Utility Analysis

BACKGROUND Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. OBJECTIVE This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. METHODS Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly’s effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. RESULTS The Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. CONCLUSIONS The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.

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Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial (Preprint)

10.2196/preprints.10866 ◽

2018 ◽

Author(s):

Fanny Kählke ◽

Claudia Buntrock ◽

Filip Smit ◽

Matthias Berking ◽

Dirk Lehr ◽

...

Keyword(s):

Cost Effectiveness ◽

Stress Management ◽

Perceived Stress ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Management Interventions ◽

Life Years ◽

The Cost

BACKGROUND Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. OBJECTIVE The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. METHODS A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). RESULTS When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. CONCLUSIONS Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. CLINICALTRIAL German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 INTERNATIONAL REGISTERED REPOR RR2-10.1186/1471-2458-13-655

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Cost-effectiveness of a community-delivered multicomponent intervention compared with enhanced standard care of obese adolescents: cost-utility analysis alongside a randomised controlled trial (the HELP trial)

BMJ Open ◽

10.1136/bmjopen-2017-018640 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018640 ◽

Cited By ~ 3

Author(s):

Monica Panca ◽

Deborah Christie ◽

Tim J Cole ◽

Silvia Costa ◽

John Gregson ◽

...

Keyword(s):

Cost Effectiveness ◽

Resource Use ◽

Standard Care ◽

Controlled Trial ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Community Settings ◽

Utility Analysis ◽

Randomised Controlled

ObjectiveTo undertake a cost-utility analysis of a motivational multicomponent lifestyle-modification intervention in a community setting (the Healthy Eating Lifestyle Programme (HELP)) compared with enhanced standard care.DesignCost-utility analysis alongside a randomised controlled trial.SettingCommunity settings in Greater London, England.Participants174 young people with obesity aged 12–19 years.InterventionsIntervention participants received 12 one-to-one sessions across 6 months, addressing lifestyle behaviours and focusing on motivation to change and self-esteem rather than weight change, delivered by trained graduate health workers in community settings. Control participants received a single 1-hour one-to-one nurse-delivered session providing didactic weight-management advice.Main outcome measuresMean costs and quality-adjusted life years (QALYs) per participant over a 1-year period using resource use data and utility values collected during the trial. Incremental cost-effectiveness ratio (ICER) was calculated and non-parametric bootstrapping was conducted to generate a cost-effectiveness acceptability curve (CEAC).ResultsMean intervention costs per participant were £918 for HELP and £68 for enhanced standard care. There were no significant differences between the two groups in mean resource use per participant for any type of healthcare contact. Adjusted costs were significantly higher in the intervention group (mean incremental costs for HELP vs enhanced standard care £1003 (95% CI £837 to £1168)). There were no differences in adjusted QALYs between groups (mean QALYs gained 0.008 (95% CI −0.031 to 0.046)). The ICER of the HELP versus enhanced standard care was £120 630 per QALY gained. The CEAC shows that the probability that HELP was cost-effective relative to the enhanced standard care was 0.002 or 0.046, at a threshold of £20 000 or £30 000 per QALY gained.ConclusionsWe did not find evidence that HELP was more effective than a single educational session in improving quality of life in a sample of adolescents with obesity. HELP was associated with higher costs, mainly due to the extra costs of delivering the intervention and therefore is not cost-effective.Trial registration numberISRCTN99840111.

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Economic evaluation of compression stockings for the prevention of venous leg ulcer recurrence in Ontario

Journal of Wound Care ◽

10.12968/jowc.2020.29.3.141 ◽

2020 ◽

Vol 29 (3) ◽

pp. 141-151 ◽

Cited By ~ 2

Author(s):

Sandjar Djalalov ◽

Shayan Sehatzadeh ◽

David H Keast ◽

William WL Wong

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Ulcer Recurrence ◽

Utility Analysis ◽

Compression Stockings ◽

Old Patients ◽

Life Years

Objective: Approximately between 1.5 and 3.0 per 1000 people are affected by venous leg ulcers (VLUs). The treatment and management of VLUs is costly and recurrence is a major concern. There is evidence that compression stockings can reduce the rate of re-ulceration compared with no compression. We present the first cost-effective analysis of compression stockings in preventing recurrence of VLUs from the perspective of the Ontario healthcare system. Method: A cost-utility analysis with a five-year time horizon was conducted. Use of compression stockings was compared with usual care (no compression stockings). We simulated a hypothetical cohort of 65-year-old patients with healed VLUs, using a state-transition model. Model input parameters were obtained mainly from the published literature. We estimated quality-adjusted life years (QALYs) gained and direct medical costs. We conducted various sensitivity analyses. Results: Compared with usual care, compression stockings were associated with higher costs and increased QALYs. Cost-utility analysis showed that the incremental cost-effectiveness ratio of compression stockings was $23,864 per QALY gained compared with no compression stockings. The most influential drivers of cost-effectiveness were the utility value of healed VLUs, cost of stockings, number of stocking replacements, monthly prevention cost and the risk of VLU recurrence. Conclusion: Compared with usual care, compression stockings were cost-effective in preventing VLUs, using a willingness-to-pay threshold of $50,000. These observations were consistent even when uncertainty in model inputs and parameters were considered.

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Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis

Journal of Medical Internet Research ◽

10.2196/18917 ◽

2020 ◽

Vol 22 (10) ◽

pp. e18917

Author(s):

Chris Boodoo ◽

Qi Zhang ◽

Heather J Ross ◽

Ana Carolina Alba ◽

Audrey Laporte ◽

...

Keyword(s):

Public Health ◽

Cost Effectiveness ◽

Standard Care ◽

Cost Effective ◽

Standard Of Care ◽

Cost Utility ◽

Cost Utility Analysis ◽

Model Parameters ◽

Microsimulation Model ◽

Utility Analysis

Background Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. Objective This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. Methods Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly’s effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. Results The Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. Conclusions The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.

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Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial

JMIR Mental Health ◽

10.2196/10866 ◽

2019 ◽

Vol 6 (5) ◽

pp. e10866 ◽

Cited By ~ 1

Author(s):

Fanny Kählke ◽

Claudia Buntrock ◽

Filip Smit ◽

Matthias Berking ◽

Dirk Lehr ◽

...

Keyword(s):

Cost Effectiveness ◽

Stress Management ◽

Perceived Stress ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Management Interventions ◽

Life Years ◽

The Cost

Background Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. Objective The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. Methods A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). Results When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. Conclusions Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. Trial Registration German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 International Registered Report Identifier (IRRID) RR2-10.1186/1471-2458-13-655

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COST-UTILITY ANALYSIS OF NT-PROBNP-GUIDED MULTIDISCIPLINARY CARE IN CHRONIC HEART FAILURE

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462312000712 ◽

2012 ◽

Vol 29 (1) ◽

pp. 3-11 ◽

Cited By ~ 18

Author(s):

Deddo Moertl ◽

Sabine Steiner ◽

Doug Coyle ◽

Rudolf Berger

Keyword(s):

Heart Failure ◽

Cost Effectiveness ◽

Patient Management ◽

Multidisciplinary Care ◽

Cost Effective ◽

Threshold Value ◽

Cost Utility ◽

Cost Utility Analysis ◽

Effective Strategy ◽

Utility Analysis

Objectives: A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective.Methods: Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality.Results: BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000.Conclusions: NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.

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Use of the Ring Wound Protector in Open Appendectomy: A Model-Based Cost-Utility Analysis

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.12.13195 ◽

2021 ◽

Vol 104 (12) ◽

pp. 1971-1976

Keyword(s):

Cost Effectiveness ◽

Decision Tree ◽

Incremental Cost ◽

Open Appendectomy ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Sensitivity Analyses ◽

Utility Analysis ◽

Wound Protector

Objective: To evaluate cost-effectiveness of ring wound protector (RWP) used in open appendectomy. Materials and Methods: The present study was a decision-tree-based analysis. Model inputs, including costs, utilities, and probabilities of surgical site infection (SSI), were retrieved from the previous studies. The incremental cost-effectiveness ratio (ICER) represented the cost of one additional quality-adjusted life day (QALD). This ratio was calculated by dividing the incremental cost [Thai Baht (THB)] by the incremental QALD. One-way sensitivity analyses were performed by varying each input parameter to see how ICER change. Monte-Carlo simulation with 5,000 replications was used to estimate probabilistic ICER and construct the acceptability curve, demonstrating how the probability of being cost-effective changed when the willingness-to-pay (WTP) threshold was shifted. Results: The deterministic ICER of 64,630.78 THB/QALD did not favor RWP use compared with the WTP threshold of 10,000 THB/QALD. However, if the threshold was shifted to 100,000 THB/QALD, it would yield approximately 75% probability of being cost-effective from RWP. Threshold analysis indicated that RWP should cost 281, 301, and 661 THB to be cost-effective at the threshold of 500, 1,000, and 10,000 THB/QALD, respectively. Conclusion: Routine RWP use might not be cost-effective when QALD is the outcome of interest. Based on the results from the present study, policy-makers could be informed that the adoption of this health technology might not be suitable. Keywords: Ring wound protector; Appendectomy; Cost-utility analysis; Decision tree model

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Hemodialysis or Transplantation for Ethiopia: A Cost Utility Analysis

Annals of Advanced Biomedical Sciences ◽

10.23880/aabsc-16000112 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Tariku Shimels

Keyword(s):

Kidney Transplantation ◽

Incremental Cost ◽

Addis Ababa ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Medline Search ◽

Life Years ◽

End Stage

Background: The burden of end stage kidney disease (ESKD) characterized with a requirement with lifesaving dialysis or kidney transplantation is estimated to be more than 1.4 million whereas the annual incidence exceeds 8% worldwide. In Ethiopia, there is no renal transplant practice whereas hemodialysis is characterized with very limited number of dialysis centers in the capital; Addis Ababa. The objective of this analysis was to evaluate the cost-utility of hemodialysis and renal transplantation in Ethiopia. Method: A cost utility evaluation (CUA) was produced to estimate if kidney transplantation would be a cost-effective alternative to hemodialysis. The decision model was developed as a decision tree that allows for comparisons of costutility evaluation between the two alternatives. While a patient perspective was used in the study, The Probabilities cost of transplant and effects included in this study were derived from the literature following a formal MEDLINE search for studies published in English language. Results: Transplantation resulted in an incremental cost of $42,623.74 and incremental utility of 3.18 quality-adjusted life years (QALYs) compared with conventional hemodialysis presented with an incremental cost of $25,902.08 but very less QALY of 0.36 over a five years’ time horizon. Given its higher incremental costs, transplantation remained more cost effective than hemodialysis (ICUR of 13414.67 vs. 71860.00 $/QALY). The one way ANOVA sensitivity analysis has also confirmed that the result of the CUA is not sensitive to any plausible parameter changes. Conclusion: Our cost utility analysis result demonstrated that the incremental cost utility ratio of a patient’s five year therapy by hemodialysis at end-stage renal disease is significantly higher than by performing therapy of kidney transplantation, by more than a factor of five times.

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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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