EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring

• Published in: European heart journal 2015-01, Vol.36 (3), p.158-169
• Main Authors: Heidbuchel, Hein, Hindricks, Gerd, Broadhurst, Paul, Van Erven, Lieselot, Fernandez-Lozano, Ignacio, Rivero-Ayerza, Maximo, Malinowski, Klaus, Marek, Andrea, Romero Garrido, Rafael F, Löscher, Steffen, Beeton, Ian, Garcia, Enrique, Cross, Stephen, Vijgen, Johan, Koivisto, Ulla-Maija, Peinado, Rafael, Smala, Antje, Annemans, Lieven
• Format: Article
• Language: English
• Subjects: Arrhythmias, Cardiac - economics; Arrhythmias, Cardiac - therapy; Cardiac Pacing, Artificial - economics; Costs and Cost Analysis; Defibrillators, Implantable - economics; Fee-for-Service Plans; Female; Follow-Up Studies; Health Personnel - economics; Health Personnel - utilization; Health Resources - economics; Health Resources - utilization; Home Care Services - economics; Humans; Long-Term Care - economics; Male; Middle Aged; Monitoring, Ambulatory - economics; Office Visits - economics; Remote Consultation - economics; Track Esc Hot Line
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehu339

Remote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits in combination with earlier detection of relevant findings. Its implementation requires investment and reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The primary end-point of this randomized prospective multicentre health economic trial was the total FU-related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU (HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers (taking national reimbursement into account) and costs from a healthcare payer perspective were evaluated. A total of 312 patients with VVI- or DDD-ICD implants from 17 centres in six EU countries were randomised to HM ON or OFF, of which 303 were eligible for data analysis. For all contacts (in-office, calendar- or alert-triggered web-based review, discussions, calls) time-expenditure was tracked. Country-specific cost parameters were used to convert resource use into monetary values. Remote FU equipment itself was not included in the cost calculations. Given only two patients from Finland (one in each group) a monetary valuation analysis was not performed for Finland. Average age was 62.4 ± 13.1 years, 81% were male, 39% received a DDD system, and 51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 ± 1.67 vs. 5.53 ± 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 ± 1.50 vs. 0.62 ± 1.25; P < 0.005), more non-office-based contacts (1.95 ± 3.29 vs. 1.01 ± 2.64; P < 0.001), more Internet sessions (11.02 ± 15.28 vs. 0.06 ± 0.31; P < 0.001) and more in-clinic discussions (1.84 ± 4.20 vs. 1.28 ± 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 ± 1.18 vs. 0.85 ± 1.43, P = 0.23) and shorter length-of-stay (6.31 ± 15.5 vs. 8.26 ± 18.6; P = 0.27), although not significant. For the whole study population, the total FU cost for providers was not different for HM ON vs. OFF [mean (95% CI): €204 (169-238) vs. €213 (182-243); range for difference (€-36 to 54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient (including other physician visits, examinations, and hospitalizations) was numerically (but not significantly) lower. There was no difference in the net financial impact on providers [profit of €408 (327-489) vs. €400 (345-455); range for dif