Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis

• Published in: Journal of medical Internet research Vol. 23; no. 3; p. e26516
• Main Authors: Jiang, Xinchan, Yao, Jiaqi, You, Joyce Hoi-Sze
• Format: Journal Article
• Language: English
• Published: Canada Gunther Eysenbach MD MPH, Associate Professor 03.03.2021; JMIR Publications
• Subjects: Ambulatory Care - economics; Ambulatory Care - methods; Analysis; Chronic illnesses; Clinical outcomes; Cohort Studies; Coronaviruses; Cost analysis; Cost-Benefit Analysis; COVID-19; COVID-19 - complications; COVID-19 - epidemiology; Data Analysis; Disease transmission; Epidemiology; GDP; Gross Domestic Product; Health care; Health status; Heart failure; Heart Failure - epidemiology; Help seeking behavior; Hong Kong - epidemiology; Hospitalization; Humans; Independent study; Markov Chains; Medical personnel; Monte Carlo Method; Monte Carlo simulation; Mortality; Original Paper; Outpatient treatment; Pandemics; Population; Probability; Quality adjusted life years; Robustness; SARS-CoV-2; Sensitivity analysis; Smartphones; Telemedicine - economics; Telemedicine - methods; Willingness to pay; Hong Kong; Hong Kong China; New York; United States > US; China; COVID-19; cost-effectiveness; heart failure; smartphone; telemonitoring; mobile health; health care avoidance
• DOI: 10.2196/26516
• ISSN: 1438-8871; 1439-4456

The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.