PMID- 32407288
OWN - NLM
STAT- MEDLINE
DCOM- 20210405
LR  - 20210405
IS  - 2291-5222 (Electronic)
IS  - 2291-5222 (Linking)
VI  - 8
IP  - 7
DP  - 2020 Jul 6
TI  - Telemonitoring Versus Usual Care for Elderly Patients With Heart Failure 
      Discharged From the Hospital in the United States: Cost-Effectiveness Analysis.
PG  - e17846
LID - 10.2196/17846 [doi]
LID - e17846
AB  - BACKGROUND: Telemonitoring-guided interventional management reduces the need for 
      hospitalization and mortality of patients with chronic heart failure (CHF). 
      OBJECTIVE: This study aimed to analyze the cost-effectiveness of usual care with 
      and without telemonitoring-guided management in patients with CHF discharged from 
      the hospital, from the perspective of US health care providers. METHODS: A 
      lifelong Markov model was designed to estimate outcomes of (1) usual care alone 
      for all postdischarge patients with CHF (New York Heart Association [NYHA] class 
      I-IV), (2) usual care and telemonitoring for all postdischarge patients with CHF, 
      (3) usual care for all postdischarge patients with CHF and telemonitoring for 
      patients with NYHA class III to IV, and (4) usual care for all postdischarge 
      patients with CHF plus telemonitoring for patients with NYHA class II to IV. 
      Model inputs were derived from the literature and public data. Sensitivity 
      analyses were conducted to assess the robustness of model. The primary outcomes 
      were total direct medical cost, quality-adjusted life years (QALYs), and 
      incremental cost-effectiveness ratio (ICER). RESULTS: In the base case analysis, 
      universal telemonitoring group gained the highest QALYs (6.2967 QALYs), followed 
      by the telemonitoring for NYHA class II to IV group (6.2960 QALYs), the 
      telemonitoring for NYHA class III to IV group (6.2450 QALYs), and the universal 
      usual care group (6.1530 QALYs). ICERs of the telemonitoring for NYHA class III 
      to IV group (US $35,393 per QALY) and the telemonitoring for NYHA class II to IV 
      group (US $38,261 per QALY) were lower than the ICER of the universal 
      telemonitoring group (US $100,458 per QALY). One-way sensitivity analysis 
      identified five critical parameters: odds ratio of hospitalization for 
      telemonitoring versus usual care, hazard ratio of all-cause mortality for 
      telemonitoring versus usual care, CHF hospitalization cost and monthly outpatient 
      costs for NYHA class I, and CHF hospitalization cost for NYHA class II. In 
      probabilistic sensitivity analysis, probabilities of the universal 
      telemonitoring, telemonitoring for NYHA class II to IV, telemonitoring for NYHA 
      class III to IV, and universal usual care groups to be accepted as cost-effective 
      at US $50,000 per QALY were 2.76%, 76.31%, 18.6%, and 2.33%, respectively. 
      CONCLUSIONS: Usual care for all discharged patients with CHF plus 
      telemonitoring-guided management for NYHA class II to IV patients appears to be 
      the preferred cost-effective strategy.
CI  - (c)Xinchan Jiang, Jiaqi Yao, Joyce HS You. Originally published in JMIR mHealth and 
      uHealth (http://mhealth.jmir.org), 06.07.2020.
FAU - Jiang, Xinchan
AU  - Jiang X
AUID- ORCID: 0000-0002-6647-2364
AD  - School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 
      Shatin, NT, China (Hong Kong).
FAU - Yao, Jiaqi
AU  - Yao J
AUID- ORCID: 0000-0003-2076-9880
AD  - School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 
      Shatin, NT, China (Hong Kong).
FAU - You, Joyce Hs
AU  - You JH
AUID- ORCID: 0000-0002-5763-7403
AD  - School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 
      Shatin, NT, China (Hong Kong).
LA  - eng
PT  - Journal Article
DEP - 20200706
PL  - Canada
TA  - JMIR Mhealth Uhealth
JT  - JMIR mHealth and uHealth
JID - 101624439
SB  - IM
MH  - Aftercare
MH  - Aged
MH  - Cost-Benefit Analysis
MH  - *Heart Failure/therapy
MH  - Hospitals
MH  - Humans
MH  - *Patient Discharge/economics
MH  - Telemedicine/*economics
MH  - United States
PMC - PMC7381019
OTO - NOTNLM
OT  - cost
OT  - cost-effectiveness analysis
OT  - heart failure
OT  - hospitalization
OT  - quality-adjusted life year
OT  - telemedicine
COIS- Conflicts of Interest: None declared.
EDAT- 2020/05/15 06:00
MHDA- 2021/04/07 06:00
PMCR- 2020/07/06
CRDT- 2020/05/15 06:00
PHST- 2020/01/16 00:00 [received]
PHST- 2020/02/29 00:00 [accepted]
PHST- 2020/02/26 00:00 [revised]
PHST- 2020/05/15 06:00 [pubmed]
PHST- 2021/04/07 06:00 [medline]
PHST- 2020/05/15 06:00 [entrez]
PHST- 2020/07/06 00:00 [pmc-release]
AID - v8i7e17846 [pii]
AID - 10.2196/17846 [doi]
PST - epublish
SO  - JMIR Mhealth Uhealth. 2020 Jul 6;8(7):e17846. doi: 10.2196/17846.