Telemedical monitoring of patients with chronic heart failure has a positive effect on total health costs

BACKGROUND: Telemedical programs for patients with chronic heart failure have shown inconsistent effects on survival and hospitalization. Few studies analyzed effects of telemedical interventions on health costs, although this outcome may determine whether or not a successful program will be adopted by health insurance providers. We evaluated a large sized telemedicine program provided by a German statutory health insurance, consisting of regular telephone contacts and, for a subgroup of the participants, provision of an electronic scale in a routine care setting. We examined the effects of the program on the total healthcare costs after one year compared to a matched control group. METHODS: The evaluation was based on reimbursement data of the statutory health insurance. Participants of the program were matched to appropriate controls using a combination of exact (e.g. 5-year age group, gender, NYHA class) and propensity score (e.g. medication, psychiatric comorbidity) matching. The total health costs after one year were calculated on the basis of regression analyses in an intention-to-treat-approach. In a sensitivity analysis, the subgroup of patients with a documented beginning of the intervention was examined. RESULTS: Two thousand six hundred twenty two patients with chronic heart failure (55% male, mean age: 73.7 years) were included in the intervention program. 1943 participants (74%) could be matched with appropriate control patients. The telemedicine monitoring program for patients with chronic heart failure reduced total health costs after 12 months of the intervention: - 276€ per quarter year in rural regions and - 18€ in urban regions compared to the control group. CONCLUSIONS: The telemedicine program could reduce total health costs, especially in rural regions in Germany.