Cost-effectiveness of a home telemonitoring system and a diagnostic algorithm in the management of heart failure in the Netherlands (Preprint)

Abstract

Heart failure (HF) is a major health concern associated with significant morbidity, mortality, and reduced quality of life for patients. Home telemonitoring (HTM) facilitates frequent or continuous assessment of disease signs and symptoms, while it has been shown to improve compliance by involving patients in their own care and to prevent emergency admissions by facilitating early detection of clinically significant changes. Diagnostic algorithms (DAs) are predictive mathematical relationships that make use of a wide range of collected data for calculating the likelihood of a particular event happening and utilise this output for prioritising patients with regards to their treatment.

Assessing the cost-effectiveness of HTM and a DA in the management of heart failure in the Netherlands. Three interventions were analysed: usual care (UC), HTM, and HTM+DA.

A previously published discrete event simulation model was used. The base-case analysis was performed according to the Dutch guidelines for economic evaluation. Sensitivity, scenario, and value of information analyses were performed. Particular attention was given to the cost-effectiveness of the DA at various levels of diagnostic accuracy of event prediction and to different patient subgroups.

HTM+DA extendedly dominates HTM and it has a deterministic incremental cost-effectiveness ratio versus UC of €27,712 per quality-adjusted life year (QALY). The model showed robustness in the sensitivity and scenario analyses. HTM+DA had a 96.0% probability of being cost-effective at a €80,000/QALY threshold. An optimal point for the threshold value for the alarm of the DA in terms of its cost-effectiveness was estimated. NYHA class IV patients were the subgroup with the worst cost-effectiveness results versus UC, while HTM+DA was found to be the most cost-effective for patients <65 years-old and for patients in NYHA class I.

Although increased costs of adopting HTM and DA in the management of HF may seemingly be an additional strain on scarce health care resources, the results of this study demonstrate that, by increasing patient life expectancy by 1.28 years and reducing their hospitalisation rate by 23% when compared to UC, the use of these technologies may be seen as an investment, as HTM+DA extendedly dominates HTM and is cost-effective versus UC at normally accepted thresholds in the Netherlands.