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Abstract

We appreciate Raymakers and Lynd's comments about our study 1 Ladapo J.A. Turakhia M.P. Ryan M.P. Mollenkopf S.A. Reynolds M.R. Health care utilization and expenditures associated with remote monitoring in patients with implantable cardiac devices. Am J Cardiol. 2016; 117: 1455-1462 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar and agree that our findings should be interpreted in the context of our inclusion criteria and other methodologic decisions. One of these decisions—to limit the population to subjects with newly implanted cardiac implantable electronic devices and at least 2 years of continuous enrollment—has both benefits and risks. A prime benefit is that it affords a uniform time horizon over which to compare patients' health care utilization and costs, as related to their clinical management with remote monitoring versus in-office monitoring. Without a uniform time horizon, cost comparisons are much less straightforward to interpret, and a cost-effectiveness analysis—rather than a cost analysis, which is what we performed—would be more appropriate because lower health care costs attributable to comparatively shorter life expectancy could be balanced against greater costs attributable to comparatively longer life expectancy. 2 Gold M.R. Siegel J.E. Russell L.B. Weinstein M.C. Cost-effectiveness in Health and Medicine. Oxford University Press, New York, NY1996 Google Scholar Cost-effectiveness analyses are important, and we have published several of them, but they require robust data on mortality, which we did not have in this data set. However, readers may be reassured that mortality rates in this population are sufficiently low to prevent only a small proportion of patients in our cohort from achieving 2 years of continuous enrollment. For example, in 1 study of newly implanted ICDs (implantable cardioverter-defibrillator), the annual mortality rate for patients similar in age to those in our cohort ranged from 5% to 9% annually. 3 Yung D. Birnie D. Dorian P. Healey J.S. Simpson C.S. Crystal E. Krahn A.D. Khaykin Y. Cameron D. Chen Z. Lee D.S. Survival after implantable cardioverter-defibrillator implantation in the elderly. Circulation. 2013; 127: 2383-2392 Crossref PubMed Scopus (72) Google Scholar Inclusion Criteria May Significantly Bias Study ResultsAmerican Journal of CardiologyVol. 120Issue 3PreviewWe read with interest the study from Ladapo et al1 reporting on health care utilization and resource use in patients receiving new cardiac implantable electronic devices (CIEDs) that are remotely monitored versus those receiving in-office monitoring. The investigators found that remotely monitoring CIED patients might result in lower costs and resource use compared with in-office monitoring. Full-Text PDF