J. Med. Internet Res. - Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: randomized controlled trial.

Tópicos

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Resumo

CKGROUND: Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up.OBJECTIVE: We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators.METHODS: Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained.RESULTS: Overall, remote monitoring did not show significant annual cost savings for the health care system (?1962.78 versus ?2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (?291.36 versus ?381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of ?888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution.CONCLUSIONS: Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations.TRIAL REGISTRATION: ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f).

Resumo Limpo

ckground heart failur patient implant defibril place signific burden health care system remot monitor allow assess devic function heart failur paramet may repres safe effect costsav method compar convent inoffic followupobject hypothes remot devic monitor repres costeffect approach paper summar econom evalu evolut manag strategi heart failur patient implant defibril evolvo studi multicent clinic trial aim measur benefit remot monitor heart failur patient implant defibrillatorsmethod two hundr patient implant wireless transmissionen implant defibril random receiv either remot monitor convent method inperson evalu patient follow month protocol schedul inoffic remot followup econom evalu intervent conduct perspect health care system patient costutil analysi perform measur whether intervent costeffect term cost per qualityadjust life year qali gainedresult overal remot monitor show signific annual cost save health care system versus p signific reduct annual cost patient remot arm comparison standard arm versus p costutil analysi perform patient qali avail patient remot arm gain qali standard arm month cost save per patient result costutil analysi evolvo studi show remot monitor costeffect domin solutionconclus remot manag heart failur patient implant defibril appear costeffect compar convent method inperson evaluationstri registr clinicaltrialsgov nct httpclinicaltrialsgovshownct archiv webcit httpwwwwebcitationorghboaf

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