The economic impact of remote control in patients with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators: single center experience

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Remote monitoring (RM) technologies have the potential to improve patient care by increasing compliance, providing early indications of heart failure (HF) decompensation, and potentially allowing for optimization of therapy to prevent HF admissions. The aim of this observational, retrospective study was to assess the clinical and economic consequences of RM vs standard monitoring (SM) through in-office cardiology visits, in patients carrying an implantable cardioverter defibrillator (ICD) or a cardiac resynchronization therapy defibrillator (CRTD). Methods Clinical and resource consumption data of this retrospective analysis were extracted from the Electrophysiology Registry of our Cardiology Unit, which has been systemically collecting patient information from January 2011 to February 2022. From a clinical standpoint, survival analysis was conducted, and incidence of CV-related hospitalizations was measured. From an economic standpoint, direct costs of RM and SM patients were collected to compare the cost per treated patient over a 2-year time horizon. Propensity score matching (PSM) was used to reduce the effect of confounding biases and the unbalance of patient characteristics at baseline. Results In the enrollment period, N=402 patients carrying ICD/CRTD met the inclusion criteria and were included in the analysis (N=189 patients -47.0%- followed through SM; N=213 patients -53.0%- followed through RM). After PSM, comparison was limited to N=191 patients in each arm (Figure 1). After a follow-up of 2 years since ICD/CRTD implantation, mortality rate for any cause was 1.6% in the RM group and 19.9% in the SM group (log-rank test, p<0.0001). Also, a lower proportion of patients in the RM group (25.1%) were hospitalized for CV-related reasons, compared to the SM group (51.3%; p<0.0001, two-sample test for proportions). Overall, the implementation of the RM program in our territory was cost-saving in both payer and hospital perspectives. The investment required to fund RM (a fee for service in the payer perspective, and staffing costs for hospitals), was more than offset by the lower rate of hospitalizations for CV-related disease. RM adoption generated savings of -€4,771 and -€6,752 per patient in 2 years, in the payer and hospital perspective, respectively (Figure 2). Conclusion RM of patients carrying ICD/CRTD improves short-term (2-year) morbidity and mortality risks, compared to SM (based on the traditional in-office visit approach) and finally reduces direct management costs for both hospitals and healthcare services