The impact of remote monitoring of implanted cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy device (CRT-D) patients on healthcare costs in the Silesian population: three-year follow-up

• Published in: Kardiologia polska Vol. 75; no. 6; pp. 573 - 580
• Main Authors: Buchta, Piotr, Tajstra, Mateusz, Kurek, Anna, Skrzypek, Michał, Świetlińska, Małgorzata, Gadula-Gacek, Elżbieta, Wasiak, Michał, Pyka, Łukasz, Gąsior, Mariusz
• Format: Journal Article
• Language: English
• Published: Poland 01.01.2017
• Subjects: Aged; Cardiac Resynchronization Therapy Devices; Defibrillators, Implantable - economics; Female; Follow-Up Studies; Health Care Costs; Hospitalization; Humans; Male; Middle Aged; Monitoring, Ambulatory - economics; Poland; cardioverter-defibrillator; heart failure; remote monitoring; healthcare costs
• ISSN: 0022-9032; 1897-4279
• DOI: 10.5603/KP.a2017.0019

The population of patients with implanted cardioverter-defibrillators (ICD) and cardiac resynchronisation therapy devices (CRT-D) is constantly growing. The use of remote-monitoring (RM) techniques in this group can significantly improve clinical outcomes, but there are limited data about the impact of RM on healthcare costs from a payer's perspective. The aim of the study was to assess the impact on costs for the healthcare system of RM in patients with ICD or CRT-D. We examined a cohort of 842 patients with ICD or CRT-D. The group was divided into two groups based on RM (or no RM [NRM]), matched according to important clinical characteristics. The subjects were followed for a maximum of three years after implantation (mean follow-up 2.11 ± 0.83 years). The overall costs for the healthcare provider in the follow-up were defined as the primary endpoint. The secondary endpoint was the use of different types of medical contact events: hospitalisation and number of in-clinic and general practitioner visits (without the number of remote transmissions). In the three-year follow-up, the reduction in the costs of treatment for National Health Care in the RM group was 33.5% (median value, p < 0.001). In patients with implanted CRT-D, the reduction reached 42.7% (p = 0.011), and with ICD it was 31.3% (p = 0.007). We observed no significant reduction in the median hospitalisation costs in the three-year follow-up in the RM group (p = NS), despite a 25% drop in the mean value. The costs of outpatient visits were slightly higher in the RM group (p = NS). In the follow-up period, there was no reduction in the number of medical contact events (p = NS). Remote monitoring in patients with implanted ICD or CRT-D devices reduces the cost for the national healthcare provider.