Health Economic Evaluation of Digital Health Interventions in the Management of Cardiovascular Disease

• Main Author: Jiang, Xinchan
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2021
• Subjects: Pharmaceutical sciences
• ISBN: 9798426803701

Background: The application of information technology and mobile internet in the health care industry takes the practice of patient care to the era of digital health. Digital health interventions (DHIs) are increasingly used in the care of cardiovascular disease (CVD). Clinical evidence showed the improved outcomes in patients with DHIs. This thesis aimed to evaluate the clinical and health economic outcomes of DHIs in CVD care. Methods: A systematic review was performed to review the health economic evaluations of DHIs in CVD care. Based upon the findings of the systematic review, three decision-analytic models were developed to simulate the clinical and health economic outcomes of DHIs in the management of CVD. Model (1) compared discharge-to-home with wearable cardioverter-defibrillator (WCD) versus discharge-to-home without WCD and stay-in-hospital for the prevention of sudden cardiac arrest (SCA) in China. Model (2) examined four approaches in the post-discharge management of heart failure (HF) in the United States: usual care (UC) alone for all patients with HF (New York Heart Association [NYHA] class I-IV), UC plus telemonitoring (TM) for all patients with HF, UC for all patients plus TM for patients in NYHA class III-IV, and UC for all patients plus TM for patients in NYHA class II-IV. Model (3) examined two approaches for managing patients with HF amid the COVID-19 pandemic in Hong Kong: TM plus current care under COVID-19 pandemic versus current care alone under COVID-19 pandemic. All model inputs were retrieved from published literature and public data. Model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). The preferred option was defined as the strategy that was effective in saving QALYs at lower cost, or at a higher cost with an acceptable II ICER less than the willingness-to-pay (WTP) threshold. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results: A total of 14 studies were identified in the systematic review. Stroke and HF were the two most frequent CVDs that were managed by DHIs. The types of devices or technologies included telephone support, short message service, video conferencing system, telemonitoring, mobile application, and wearable medical device. In the base-case analyses of the decisionanalytic models, model (1) showed discharge-to-home with WCD was the most effective strategy (3.0990 QALYs) with an ICER less than the WTP threshold of US$57,315/QALY when the daily cost of WCD was less than US$48. Model (2) showed UC for all patients plus TM for patients in NYHA class II-IV gained more QALYs (6.2960 versus 6.1530 QALYs) at higher cost (US$243,354 versus US$238,146) than UC alone for all patients with an ICER of US$38,261/QALY (less than the WTP threshold of US$50,000/QALY). Model (3) showed TM plus current care under COVID-19 pandemic was more effective (1.9007 versus 1.8345 QALYs) at higher cost (US$15,888 versus US$15,603) with an ICER of US$4,292/QALY (less than the WTP threshold of US$48,937/QALY), when compared to current care alone under COVID-19 pandemic. In one-way sensitivity analysis, the base-case result in model (1) was highly subject to the daily cost of WCD. In model (2) and model (3), the ICERs were robust to variation of all parameters. In probabilistic sensitivity analyses, the probability of discharge-to-home with WCD in model (1) to be accepted as cost-effective was 100% at the daily cost of US$24 and 94.16% at US$48 at the WTP threshold of US$57,315/QALY in China. In model (2), the probability of UC for all patients plus TM for patients in NYHA class II-IV to be accepted as cost-effective was 76.31% at the WTP threshold of US$50,000/QALY in the United States. In model (3), TM plus current care under COVID-19 pandemic was accepted as cost-effective in 99.22% of time at the WTP threshold of US$48,937/QALY in Hong Kong. III Conclusions: The innovative use of digital technologies appears to be cost-effective in the management of CVD in developing and developed regions.