COST-EFFECTIVENESS ANALYSIS FOR THE USE OF INTERVENTIONAL DECENTRALIZED TELEMONITORING (IDTM) IN HYPERTENSION THERAPY

Abstract

Objective: We calculate quality-adjusted life years (QALY) and incremental cost-effectiveness ratio (ICER) for the use of interventional decentralized telemonitoring (idTM) in hypertension therapy. Both values are key performance indicators for cost-benefit and cost-effectiveness analysis of medical interventions. The calculations compare blood pressure adjustment and the correlated reduction in risk of morbidity and mortality between idTM and standard therapy (ST). Prior studies have shown idTM to significantly reduce the time required to reach blood pressure targets as well as to reduce the variability of blood pressure values. IdTM also allows maintaining blood pressure on target for a longer duration than ST. Design and method: Our QALY evaluation only takes myocardial infarction (MI) and stroke, the two most prominent comorbidities of hypertension, into account. Thus, the achievable QALY are likely to be underestimated by this analysis. We assume a linear correlation between elevated blood pressure and the risk of morbidity and mortality. Data on prevalence and morbidity have been included from statistical and medical publications on the German population while data on life quality come from an EQ-5D-based study performed in the US. Results: We calculate the ICER for both for the difference in QALY and blood pressure reduction in mmHg. The latter allows evaluating the cost-effectiveness of idTM independent of specific comorbidities. Conclusions: Even though idTM adds cost to the treatment of hypertension, we find that the resulting improvement of blood pressure significantly improves QALY and ICER over ST. Therefore, idTM in hypertension therapy is a promising concept both from a medical and cost-effectiveness point of view. Especially in the context of the upcoming evaluation of digital health applications (DiGA) by the German Federal Institute for Drugs and Medical Devices (BfArM), this is a crucial result. Furthermore, the results suggest idTM as a sensible candidate for addition as an element of standard care in Germany.