Cost-effectiveness of a telephone health coaching and remote exercise monitoring for peripheral artery disease (TeGeCoach)

Introduction The number of people with peripheral arterial disease (PAD) increased by almost 25% between 2000 and 2010. The economic burden on healthcare systems caused by PAD will continue to rise because of the aging population and a further increase in risk factors. The aim of the study was to examine the cost-effectiveness of the 12-month patient-centered ‘Telephone Health Coaching and Remote Exercise Monitoring for Peripheral Artery Disease’ (TeGeCoach) program in a randomized controlled trial. Methods This is a cost-effectiveness analysis based on a two-arm, parallel-group, open-label, pragmatic, randomized-controlled clinical trial conducted by three German statutory health insurance funds with follow-up assessments after 12 and 24 months. Claims data for the calculation of costs and questionnaire data for the quantification of quality-adjusted life years (QALYs) based on the EQ5D-5L were used. From a healthcare payer’s perspective, cost-effectiveness was examined over 24 months follow-up using intention-to-treat (ITT) and modified ITT (mITT) and per protocol (PP) approaches. Results Assuming intervention costs of €672, the point estimates for the ITT analysis over 24 months showed non-significantly higher costs in the IG of €2,003 and non-significantly higher QALYs of 0.02 compared to the control group. At a willingness to pay (WTP) threshold of €50,000, the probability of the TeGeCoach being cost-effective was 30%. Under the same assumptions, the mITT and the PP approach resulted in probabilities for cost-effectiveness of 79% and, 95%, respectively. Conclusion As demonstrated by the PP- and mITT-analysis, the treatment of PAD by TeGeCoach might be cost-effective under favorable assumptions. However, applying the stricter criteria represented by the ITT scenario, TeGeCoach couldn’t demonstrate its cost-effectiveness. Therefore, before TeGeCoach should be used in healthcare practice, it is necessary to adapt the program implementation. The effectiveness of these adjustments should then be verified in further studies.