Economic evaluation of remote patient monitoring and organizational analysis according to patient involvement: a scoping review.

Abstract

A literature review concerning the economic evaluation of telemonitoring was requested by the authority in charge of health evaluation in France, in a context of deployment of remote patient monitoring and identification of its financing. Due to the heterogeneity of existing telemonitoring solutions, it was necessary to stratify the evaluation according to patient involvement. Three levels of patient involvement are considered: weak (automated monitoring), medium (monitoring supported by a professional), and strong (active remote participation). We performed a scoping review to provide a comprehensive overview of different systems of telemonitoring and their reported cost-effectiveness. Following PRISMA-ScR guidelines, a search was performed in four databases: PubMed, MEDLINE, EMBASE, and Cochrane Library between January 1, 2013 and May 19, 2020. Remote patient monitoring should include the combination of three elements: a connected device, an organizational solution for data analysis and alert management, and a system allowing personalized interactions, and three degrees of involvement. We identified 61 eligible studies among the 489 records identified. Heart failure remains the pathology most represented in the studies selected (n=24). The cost-utility analysis was chosen in a preponderant way (n=41). Forty-four studies (72 percent) reported that the intervention was expected cost-effective. Heterogeneity has been observed in the remote monitoring solutions but all systems are reported cost-effective. The small number of long-term studies does not allow conclusions to be drawn on the transposability. Remote patient monitoring is reported to be cost-effective whatever the system and patient involvement.