February 19, 2021Journal of Medical Internet ResearchOpen Access

Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis

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Why the study?

During the COVID-19 pandemic, medical care avoidance increased, prompting evaluation of the clinical and economic outcomes of adding telemonitoring to heart failure management in Hong Kong.

Does adding a smartphone-based telemonitoring program to usual care improve cost-effectiveness (QALYs and costs) in older patients with heart failure during the COVID-19 pandemic?

Structured PICO

Does adding a smartphone-based telemonitoring program to usual care improve cost-effectiveness (QALYs and costs) in older patients with heart failure during the COVID-19 pandemic?

Population

Hypothetical cohort of older patients (age ≥65 years) with heart failure in Hong Kong, distributed across NYHA classes I-IV.

Intervention

Smartphone-based telemonitoring program (daily transmission of heart rate, blood pressure, weight, and symptom reporting) added to multidisciplinary care under COVID-19 conditions.

Comparator

Multidisciplinary care under COVID-19 conditions alone (usual care with potential COVID-19-related health care avoidance).

Outcome

Direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over a 10-year time horizon.

Adding a smartphone-based telemonitoring program to usual care for older heart failure patients during the COVID-19 pandemic is a highly cost-effective strategy in Hong Kong.

Limitations

The cohort-based Markov model simplified real-life HF events with a limited number of health states.
Other factors can impact the cost-effectiveness of HF management, such as changes in influenza infection rates.
The impact of telemonitoring on HF hospitalization and all-cause mortality varied among different types of telemonitoring.

Implication

Telemonitoring may be cost-effective for HF care during pandemics; leaves open need for prospective trials before practice change.

Abstract

BACKGROUND: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). OBJECTIVE: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. METHODS: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. RESULTS: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.