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

BACKGROUND Heart failure is a major health concern associated with significant morbidity, mortality, and reduced quality of life for patients. Home telemonitoring facilitates frequent or continuous assessment of disease signs and symptoms, as well as 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 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. OBJECTIVE Assessing the cost-effectiveness of home telemonitoring and a diagnostic algorithm in the management of heart failure in the Netherlands. Three interventions were analysed: usual care, home telemonitoring, and home telemonitoring plus a diagnostic algorithm. METHODS 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 diagnostic algorithm at various levels of diagnostic accuracy of event prediction and to different patient subgroups. RESULTS Home telemonitoring plus the diagnostic algorithm extendedly dominates home telemonitoring alone and it has a deterministic incremental cost-effectiveness ratio versus usual care of €27,712 per quality-adjusted life year. The model showed robustness in the sensitivity and scenario analyses. Home telemonitoring plus the diagnostic algorithm had a 96.0% probability of being cost-effective at the appropriate €80,000 per quality-adjusted life year threshold. An optimal point for the threshold value for the alarm of the diagnostic algorithm in terms of its cost-effectiveness was estimated. New York Heart Association (NYHA) class IV patients were the subgroup with the worst cost-effectiveness results versus usual care, while home telemonitoring plus the diagnostic algorithm was found to be the most cost-effective for patients <65 years-old and for patients in New York Heart Association (NYHA) class I. CONCLUSIONS Although increased costs of adopting home telemonitoring plus the diagnostic algorithm in the management of heart failure 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 usual care, the use of this technology may be seen as an investment, as home telemonitoring plus the diagnostic algorithm in its current form extendedly dominates home telemonitoring alone and is cost-effective versus usual care at normally accepted thresholds in the Netherlands. CLINICALTRIAL