Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial

• Published in: Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2022-10, Vol.89 (5), p.105368-105368, Article 105368
• Main Authors: Bernard, Laurene, Valsecchi, Verushka, Mura, Thibault, Aouinti, Safa, Padern, Guillaume, Ferreira, Rosanna, Pastor, Jenica, Jorgensen, Christian, Mercier, Grégoire, Pers, Yves-Marie
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Connected monitoring; Cost-Benefit Analysis; Cost-effectiveness; Humans; Life Sciences; Medico-economic study; QALY; Quality-Adjusted Life Years; Rheumatoid arthritis; Telemedicine
• ISSN: 1297-319X; 1778-7254
• DOI: 10.1016/j.jbspin.2022.105368

•Connected monitoring of RA patients reduces in-person visits and seems to improve patient health status.•Connected monitoring is less expensive than conventional face-to-face monitoring.•Connected monitoring of RA patients initiating DMARD treatment appears cost-effective. Rheumatoid arthritis (RA) is a prevalent and disabling disease that is the source of significant direct and indirect costs. The current recommended therapeutic strategy is based on the rapid introduction of therapy with conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs) combined with regular disease monitoring by the rheumatologist. The onerous nature of such intense monitoring has motivated the development of new, less demanding strategies such as telemedicine. This study aimed to estimate the cost-effectiveness of the connected monitoring of RA patients initiating a new DMARD therapy versus conventional monitoring. An economic evaluation based on a randomized controlled trial of 89 patients was conducted. The patients in the intervention group (n=45) were monitored using a connected monitoring interface on a smartphone, while patients in the control group (n=44) were conventionally monitored. Health outcomes were measured as the gain in quality-adjusted life-years (QALYs), assessed using the EuroQol-5D questionnaire. Resource use and health outcomes were collected alongside the trial and at the six-month follow-up using application data and the related clinical case manager time, visits, hospitalisations, and transport records. These outcomes were valued using externally collected data on unit costs and QALY weights. Compared to conventionally monitored patients, patients receiving connected monitoring had a slightly greater but not significant gain in the average QALY of 0.07. The economic analysis found that connected monitoring resulted in a significant cost reduction of 72€ (2927€ vs. 2999€, P