Abstract
BackgroundCost-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.MethodsUnder 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.ResultsAfter 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).ConclusionsThis 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 registrationClinicalTrials.gov: (Identifier: NCT02234245). Registered 09 September 2014 - Prospectively registered.
Highlights
Cost-effectiveness studies on pacemakers have increased in the last years
Intervention description The PONIENTE trial was conducted on older patients (81 years old on average) recruited in the Poniente Hospital (Almeria–Spain) implanted with commercially available pacemakers equipped with the Medtronic CareLink® Network
The number of visits to the hospital (CM = 7.49 and remote monitoring (RM) = 4.38 on average in the total 5-years of follow up period) and/or transmissions from home (RM = 6.62 on average in the total 5years of follow up period) for each patient and year depended on the type of pacemaker implanted and patient characteristics
Summary
Cost-effectiveness studies on pacemakers have increased in the last years. 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. Existing research has demonstrated RM as effective as hospital monitoring [1, 6,7,8,9], in terms of safety [3] and reduction of the time to clinical decision and intervention It provides rapid detection of cardiovascular events [10] or device malfunction as well as reduces inappropriate shocks and spares implantable cardioverter defibrillators’ batteries [9, 11]. It is essential to educate and train the patients properly regarding the purpose and benefits of RM, its usage, and limitations [16] so that their preferences for in-hospital follow-up could be reduced [17]. This is related to social acceptance of telehealth, one of the three dimensions jointly utility and usability that would help predict how a new technology will be utilized with patients [18, 19]
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