Key result
Telemetric monitoring increases average monthly costs ~35% versus standard care.
Why the study?
Telemedicine monitoring of patients with implantable cardioverter-defibrillators is generally considered safer, more effective, and economically advantageous, but its long-term economic benefit in the Czech Republic was not assessed.
Does remote monitoring using the Home Monitoring system reduce costs compared to standard outpatient care in patients with newly implanted ICDs?
RCT (n=198)
Open-label
1:1
No
Does remote monitoring using the Home Monitoring system reduce costs compared to standard outpatient care in patients with newly implanted ICDs?
Remote monitoring of ICD patients reduces outpatient visits and transport costs, but overall costs may be higher depending on reimbursement models for the monitoring technology.
Supports Czech insurer cost savings via fewer visits; leaves open reimbursement policy changes outside this setting.
Ăvod: TelemedicĂnskĂŠ sledovĂĄnĂ pacientĹŻ s implantabilnĂmi kardiovertery-defibrilĂĄtory (ICD) je dnes obecnÄ povaĹžovĂĄno za bezpeÄnÄjĹĄĂ, ĂşÄinnÄjĹĄĂ a ekonomicky vĂ˝hodnÄjĹĄĂ. CĂlem prĂĄce bylo posoudit dlouhodobĂ˝ ekonomickĂ˝ pĹĂnos dĂĄlkovĂŠho sledovĂĄnĂ pacientĹŻ s novÄ implantovanĂ˝m ICD za pomocĂ systĂŠmu Home Monitoring™ (HM) ve srovnĂĄnĂ se standardnĂ ambulantnĂ pĂŠÄĂ v podmĂnkĂĄch ÄR.Metody: Pacienti byli randomizovĂĄni k dĂĄlkovĂŠmu sledovĂĄnĂ systĂŠmem HM s dennĂmi automatickĂ˝mi pĹenosy dat a ambulantnĂ kontrolou v intervalu 12 mÄsĂcĹŻ (HM+) nebo ke standardnĂm ambulantnĂm kontrolĂĄm (HM-). StanovenĂ nĂĄkladĹŻ bylo provedeno na zĂĄkladÄ ĂşÄtĹŻ zdravotnĂch pojiĹĄĹĽoven, pĹĂmĂ˝ch nĂĄkladĹŻ pacientĹŻ a provoznĂch nĂĄkladĹŻ systĂŠmu HM jako prĹŻmÄrnÄ vynaloĹženĂŠ na jednoho pacienta a mÄsĂc sledovĂĄnĂ.VĂ˝sledky: SledovĂĄno bylo celkem 198 pacientĹŻ po dobu v prĹŻmÄru 37,4 ± 15,2 mÄsĂce. Ve skupinÄ HM+ byl za dobu sledovĂĄnĂ redukovĂĄn poÄet plĂĄnovanĂ˝ch kontrol o 48 % (p < 0,001). Ve skupinÄ HM+ byla zaznamenĂĄna vĂ˝znamnÄ kratĹĄĂ dĂŠlka hospitalizace. NĂĄkladovĂĄ data byla zĂskĂĄna celkem u 75 % pacientĹŻ. Ve skupinÄ HM- byly zaznamenĂĄny vyĹĄĹĄĂ nĂĄklady za ambulantnĂ pĂŠÄi (223 ± 99 KÄ vs. 189 ± 93 KÄ, p = 0,039) i transport zdravotnĂ dopravnĂ sluĹžbou (640 ± 314 KÄ vs. 367 ± 187 KÄ, p = 0,003). PĹi zapoÄtenĂ nĂĄkladĹŻ na provoz systĂŠmu HM k ambulantnĂ pĂŠÄi a pĹepravÄ nebyl rozdĂl mezi skupinami signifikantnĂ, ale pokud byla do nĂĄkladĹŻ promĂtnuta takĂŠ Ăşhrada vĂ˝konu dĂĄlkovĂŠ monitorace a poĹĂzenĂ domĂĄcĂ pacientskĂŠ jednotky, byl jiĹž prĹŻmÄrnĂ˝ nĂĄklad vyĹĄĹĄĂ pro skupinu HM+ (541 ± 188 KÄ vs. 401 ± 332 KÄ, p = 0,002). NĂĄkladovÄ neutrĂĄlnĂ by v takovĂŠm pĹĂpadÄ zĹŻstal za pĹedpokladu hrazenĂŠ pĹepravy vĹĄech pacientĹŻ k ambulantnĂm kontrolĂĄm.ZĂĄvÄr: SystĂŠm HM byl dosud v ÄR u pacientĹŻ s jedno- nebo dvoudutinovĂ˝mi ICD z hlediska vynaloĹženĂ˝ch vĂ˝dajĹŻ nĂĄkladovÄ vĂ˝hodnĂ˝ pro zdravotnĂ pojiĹĄĹĽovny. PĹi kalkulaci tĂŠto Ăşhrady na vrub plĂĄtcĹŻ zdravotnĂ pĂŠÄe by systĂŠm HM zachoval nĂĄkladovou neutralitu pouze v pĹĂpadÄ hrazenĂŠ pĹepravy vÄtĹĄiny pacientĹŻ. KlinickĂ˝ prospÄch dĂĄlkovĂŠ monitorace bezprostĹednÄ plyne z kontinuity sledovĂĄnĂ, moĹžnosti velmi ÄasnĂŠ detekce udĂĄlostĂ a patĹiÄnĂŠ lĂŠkaĹskĂŠ intervence, proto se domnĂvĂĄme, Ĺže systĂŠm HM by mÄl bĂ˝t hrazen automaticky u vĹĄech pacientĹŻ s implantovanĂ˝m ICD, byĹĽ za cenu v kontextu celĂŠho zdravotnickĂŠho rozpoÄtu nevĂ˝znamnĂŠho navýťenĂ nĂĄkladĹŻ.
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Bulava et al. (2015) conducted an RCT in Patients with newly implanted single- or dual-chamber implantable cardioverter-defibrillators (ICD) (n=198). Home Monitoring™ (HM) system vs. Standard outpatient follow-up was evaluated on Average total costs per patient per month (including outpatient care, transport, HM operating costs, remote monitoring reimbursement, and patient unit) (p=0.002).
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