Economic Evaluations of Algorithm-Enabled Remote Monitoring of Cardiac Implantable Electronic Devices: Systematic Review

Background Algorithm-enabled remote monitoring using cardiac implantable electronic devices (CIEDs) is increasingly used to support earlier detection of clinical deterioration in heart failure and in at-risk populations. However, the economic value of these technologies remains uncertain because intervention design, implementation, and evaluation methods vary. Objective This study aimed to systematically identify, appraise, and synthesize full economic evaluations of algorithm-enabled CIED remote monitoring in adults with established heart failure or at risk of heart failure. Methods A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Searches were performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library, with supplementary searches of health technology assessment sources. Eligible studies reported full economic evaluations of algorithm-enabled remote monitoring linked to CIEDs. Data were extracted using a structured form and synthesized narratively due to heterogeneity. Methodological and reporting quality were assessed using the CHEQUE (Criteria for Health Economic Quality Evaluation) checklist and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) 2022 statement. One reviewer screened records and extracted the data. A second reviewer independently checked subsets of the screening decisions and extracted the data. Results Ten economic evaluations were included. They used models, trial data, or observational data; some were reported within health technology assessments. Substantial heterogeneity was observed in population definitions, intervention characteristics, algorithm types, monitored parameters, clinical response pathways, and economic methods. Cost-effectiveness and cost-utility analyses were most common, with time horizons ranging from short-term follow-up to lifetime modeling. Several studies reported economically favorable findings, including dominance (ie, less costly with better health outcomes) or cost-effectiveness. However, outcomes varied across studies, and favorable estimates often relied on assumptions about reduced hospitalization and length of stay, while quality-adjusted life year gains were generally modest. Reporting of key implementation factors, including alert burden and diagnostic performance, was limited. Conclusions There is economic evidence for algorithm-enabled CIED remote monitoring suggesting potential value in some settings, but the evidence remains methodologically heterogeneous and difficult to compare directly across studies. Findings are sensitive to differences in intervention design, modeling approaches, and clinical input data, which limit certainty and transferability. More robust and standardized evidence is needed before economic conclusions can be applied confidently across different devices, algorithms, and health care settings.