Investigators report a positive incremental net monetary benefit of nearly $6800 when patients with heart failure use a telehealth solution.
Anne Sig Vestergaard, PhD
A telehealth solution for monitoring heart failure was highly cost-effective.
Anne Sig Vestergaard, PhD, and colleagues studied 274 heart failure patients to assess the cost-effectiveness of telehealth as an add-on to standard care. The investigators found that there was a positive incremental net monetary benefit of nearly $6800.
Vestergaard, from the business and management department at Aalborg University in Denmark, and the team conducted a primary analysis with 134 patients in the intervention group and 140 in the control group from January 2016-March 2018. Eligible participants had a diagnosis of heart failure , a New York Heart Association classification of II-IV, and were expected to benefit from telehealth.
Patients in the telehealth group were monitored by educated municipality nurses. Patients were contacted by phone from a nurse and an appointment was made to discuss whether the patient wanted to receive a Telekit—a tablet, a digital blood pressure monitor, and a scale—in their home or at a municipality health center. Patients were instructed to perform measurements once or twice a week and the Telekit automatically reminded patients to do so. The nurses were trained in heart failure and telemonitoring and were responsible to educate and monitor the patients.
If a patient who was monitored had physical measurements outside of predefined thresholds (systolic blood pressure 100-170 mmHg; diastolic blood pressure 90-50 mmHg; pulse 80-55 beats per minute; and weight + 2 kg compared to baseline), the nurse had the option to:
Those in the control group received standard care. Participants were offered rehabilitation of screening for risk factors and dietary advice, among other lifestyle changes. Rehabilitation generally lasted 3-6 months and was managed by general practitioners or outpatient clinics.
Within the one-year follow-up period, the group who used Telekit had a consistently lower resource consumption across all healthcare cost categories—hospitalizations, outpatient contacts, municipality costs, etc.—than the group that received usual care. The total raw difference was $7426 for an overall reduction of total healthcare costs by 35% with the use of the telemedicine platform. The lower mean cost per patient was driven by lower costs associated with hospitalizations (intervention group, $6623 vs control group, $11,876; P = .01).
The adjusted cost difference was $6675 (95% CI, −8736 to −1456), which indicated a significantly lower total mean cost per patient in the telehealth group than the control group. Telekit also provided a significant cost saving of $7255 (95% CI, −9483 to −1595). The telemedicine tool was proven to be cost-effective (net monetary benefit, $7243).
There was an insignificant gain in health-related quality of life among the telehealth participants (difference .0034; 95% CI, -.0711 to .078).
Although Telekit was found to be highly cost-effective, questions remain as to why, the investigators wrote. Future studies should seek to improve the understanding of why some interventions may prove effective and cost-effective, while others do not. The findings of those trials could increase the cost-effectiveness of future telehealth solutions.
The study, “Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial,” was published online in BMJ Open.