J. Med. Internet Res. - Replacing ambulatory surgical follow-up visits with mobile app home monitoring: modeling cost-effective scenarios.

Tópicos

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Resumo

CKGROUND: Women's College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications.OBJECTIVE: The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients.METHODS: This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks.RESULTS: This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine health care system costs alone, in-person follow-up is $38 CAD ($35 USD) more expensive than mobile app follow-up care over the first postoperative month. The baseline difference in effect is modeled to be zero based on clinical trials examining the effectiveness of telephone follow-up care in similar patient populations. An incremental cost-effectiveness ratio (ICER) is not reportable in this scenario. An incremental net benefit (INB) is reportable, and reflects merely the cost difference between the two interventions for any willingness-to-pay value (INB=$245 CAD). The cost-effectiveness of mobile app follow-up even holds in scenarios where all mobile patients attend one in-person follow-up.CONCLUSIONS: Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients. It can be cost-effective from a societal and health care system perspective.

Resumo Limpo

ckground women colleg hospit wch offer special surgic procedur includ ambulatori breast reconstruct postmastectomi breast cancer patient patient receiv ambulatori surgeri low rate postop event necessit clinic visit increas mobil monitor followup care use overcom distanc patient must travel receiv special care reduc cost societi wch complet feasibl studi use mobil app qoc health inc toronto suggest high patient satisfact adequ detect postop complicationsobject propos costeffect studi model replac convent inperson postop followup care mobil app followup care follow ambulatori breast reconstruct postmastectomi breast cancer patientsmethod societ perspect costeffect analysi wherein cost assess irrespect payer patientcaregiv health care system extern born cost calcul within first postop month base cost inform provid wch qoc health inc effect telemedicin convent followup care measur success surgic outcom day postop model base previous clinic trial contain similar patient popul surgic risksresult cost assum patient enrol bringyourowndevic byod mobil app followup per year inperson followup attend convent arm within first month postop total cost differ mobil app inperson followup care cad usd base current exchang rate inperson followup expens cad mobil app followup care cad take account total health care system patient extern born cost examin health care system cost alon inperson followup cad usd expens mobil app followup care first postop month baselin differ effect model zero base clinic trial examin effect telephon followup care similar patient popul increment costeffect ratio icer report scenario increment net benefit inb report reflect mere cost differ two intervent willingnesstopay valu inb cad costeffect mobil app followup even hold scenario mobil patient attend one inperson followupconclus mobil app followup care suitabl target lowrisk postop ambulatori patient can costeffect societ health care system perspect

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