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EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring

(2015) EUROPEAN HEART JOURNAL. 36(3). p.158-169
Author
Organization
Abstract
Aim: Remote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits in combination with earlier detection of relevant findings. Its implementation requires investment and reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The primary end-point of this randomized prospective multicentre health economic trial was the total FU-related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU (HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers (taking national reimbursement into account) and costs from a healthcare payer perspective were evaluated. Methods and results: Atotal of 312 patients with VVI-or DDD-ICD implants from 17 centres in six EU countries were randomised to HMON or OFF, of which 303 were eligible for data analysis. For all contacts (in-office, calendar-or alert-triggered web-based review, discussions, calls) time-expenditure was tracked. Country-specific cost parameters were used to convert resource use into monetary values. Remote FU equipment itself was not included in the cost calculations. Given only two patients from Finland (one in each group) a monetary valuation analysis was not performed for Finland. Average age was 62.4 +/- 13.1 years, 81% were male, 39% received a DDD system, and 51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 +/- 1.67 vs. 5.53 +/- 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 +/- 1.50 vs. 0.62 +/- 1.25; P < 0.005), more non-office-based contacts (1.95+3.29 vs. 1.01 +/- 2.64; P < 0.001), more Internet sessions (11.02 +/- 15.28 vs. 0.06 +/- 0.31; P < 0.001) and more in-clinic discussions (1.84 +/- 4.20 vs. 1.28 +/- 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 +/- 1.18 vs. 0.85 +/- 1.43, P = 0.23) and shorter length-of-stay (6.31 +/- 15.5 vs. 8.26 +/- 18.6; P = 0.27), although not significant. For the whole study population, the total FU cost for providers was not different for HM ON vs. OFF [mean (95% CI): (sic)204 169-238) vs. (sic)213 (182-243); range for difference ((sic)-36 to 54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient (including other physician visits, examinations, and hospitalizations) was numerically (but not significantly) lower. There was no difference in the net financial impact on providers [profit of (sic)408 (327-489) vs. (sic)400 (345-455); range for difference ((sic)-104 to 88), NS], but there was heterogeneity among countries, with less profit for providers in the absence of specific remote FU reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases where such reimbursement exists (Germany and UK). Quality of life (SF-36) was not different. Conclusion: For all the patients as a whole, FU-related costs for providers are not different for remote FU vs. purely in-office FU, despite reorganized care. However, disparity in the impact on provider budget among different countries illustrates the need for proper reimbursement to ensure effective remote FU implementation.
Keywords
ECOST, SAFETY, EFFICACY, PACEMAKER, CIEDS, TRANSFERABILITY, MANAGEMENT, FAILURE, IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS, ELECTRONIC DEVICES, Health economics, Follow-up, Devices, Remote monitoring, Implantable cardioverter defibrillator

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Citation

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MLA
Heidbuchel, Hein et al. “EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a Provider Perspective in Five European Countries on Costs and Net Financial Impact of Follow-up with or Without Remote Monitoring.” EUROPEAN HEART JOURNAL 36.3 (2015): 158–169. Print.
APA
Heidbuchel, H., Hindricks, G., Broadhurst, P., Van Erven, L., Fernandez-Lozano, I., Rivero-Ayerza, M., Malinowski, K., et al. (2015). EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. EUROPEAN HEART JOURNAL, 36(3), 158–169.
Chicago author-date
Heidbuchel, Hein, Gerd Hindricks, Paul Broadhurst, Lieselot Van Erven, Ignacio Fernandez-Lozano, Maximo Rivero-Ayerza, Klaus Malinowski, et al. 2015. “EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a Provider Perspective in Five European Countries on Costs and Net Financial Impact of Follow-up with or Without Remote Monitoring.” European Heart Journal 36 (3): 158–169.
Chicago author-date (all authors)
Heidbuchel, Hein, Gerd Hindricks, Paul Broadhurst, Lieselot Van Erven, Ignacio Fernandez-Lozano, Maximo Rivero-Ayerza, Klaus Malinowski, Andrea Marek, Rafael F Romero Garrido, Steffen Löscher, Ian Beeton, Enrique Garcia, Stephen Cross, Johan Vijgen, Ulla-Maija Koivisto, Rafael Peinado, Antje Smala, and Lieven Annemans. 2015. “EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a Provider Perspective in Five European Countries on Costs and Net Financial Impact of Follow-up with or Without Remote Monitoring.” European Heart Journal 36 (3): 158–169.
Vancouver
1.
Heidbuchel H, Hindricks G, Broadhurst P, Van Erven L, Fernandez-Lozano I, Rivero-Ayerza M, et al. EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring. EUROPEAN HEART JOURNAL. 2015;36(3):158–69.
IEEE
[1]
H. Heidbuchel et al., “EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring,” EUROPEAN HEART JOURNAL, vol. 36, no. 3, pp. 158–169, 2015.
@article{6995180,
  abstract     = {Aim: Remote follow-up (FU) of implantable cardiac defibrillators (ICDs) allows for fewer in-office visits in combination with earlier detection of relevant findings. Its implementation requires investment and reorganization of care. Providers (physicians or hospitals) are unsure about the financial impact. The primary end-point of this randomized prospective multicentre health economic trial was the total FU-related cost for providers, comparing Home Monitoring facilitated FU (HM ON) to regular in-office FU (HM OFF) during the first 2 years after ICD implantation. Also the net financial impact on providers (taking national reimbursement into account) and costs from a healthcare payer perspective were evaluated. 
Methods and results: Atotal of 312 patients with VVI-or DDD-ICD implants from 17 centres in six EU countries were randomised to HMON or OFF, of which 303 were eligible for data analysis. For all contacts (in-office, calendar-or alert-triggered web-based review, discussions, calls) time-expenditure was tracked. Country-specific cost parameters were used to convert resource use into monetary values. Remote FU equipment itself was not included in the cost calculations. Given only two patients from Finland (one in each group) a monetary valuation analysis was not performed for Finland. Average age was 62.4 +/- 13.1 years, 81% were male, 39% received a DDD system, and 51% had a prophylactic ICD. Resource use with HM ON was clearly different: less FU visits (3.79 +/- 1.67 vs. 5.53 +/- 2.32; P < 0.001) despite a small increase of unscheduled visits (0.95 +/- 1.50 vs. 0.62 +/- 1.25; P < 0.005), more non-office-based contacts (1.95+3.29 vs. 1.01 +/- 2.64; P < 0.001), more Internet sessions (11.02 +/- 15.28 vs. 0.06 +/- 0.31; P < 0.001) and more in-clinic discussions (1.84 +/- 4.20 vs. 1.28 +/- 2.92; P < 0.03), but with numerically fewer hospitalizations (0.67 +/- 1.18 vs. 0.85 +/- 1.43, P = 0.23) and shorter length-of-stay (6.31 +/- 15.5 vs. 8.26 +/- 18.6; P = 0.27), although not significant. For the whole study population, the total FU cost for providers was not different for HM ON vs. OFF [mean (95% CI): (sic)204 169-238) vs. (sic)213 (182-243); range for difference ((sic)-36 to 54), NS]. From a payer perspective, FU-related costs were similar while the total cost per patient (including other physician visits, examinations, and hospitalizations) was numerically (but not significantly) lower. There was no difference in the net financial impact on providers [profit of (sic)408 (327-489) vs. (sic)400 (345-455); range for difference ((sic)-104 to 88), NS], but there was heterogeneity among countries, with less profit for providers in the absence of specific remote FU reimbursement (Belgium, Spain, and the Netherlands) and maintained or increased profit in cases where such reimbursement exists (Germany and UK). Quality of life (SF-36) was not different. 
Conclusion: For all the patients as a whole, FU-related costs for providers are not different for remote FU vs. purely in-office FU, despite reorganized care. However, disparity in the impact on provider budget among different countries illustrates the need for proper reimbursement to ensure effective remote FU implementation.},
  author       = {Heidbuchel, Hein and Hindricks, Gerd and Broadhurst, Paul and Van Erven, Lieselot and Fernandez-Lozano, Ignacio and Rivero-Ayerza, Maximo and Malinowski, Klaus and Marek, Andrea and Romero Garrido, Rafael F and Löscher, Steffen and Beeton, Ian and Garcia, Enrique and Cross, Stephen and Vijgen, Johan and Koivisto, Ulla-Maija and Peinado, Rafael and Smala, Antje and Annemans, Lieven},
  issn         = {0195-668X},
  journal      = {EUROPEAN HEART JOURNAL},
  keywords     = {ECOST,SAFETY,EFFICACY,PACEMAKER,CIEDS,TRANSFERABILITY,MANAGEMENT,FAILURE,IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS,ELECTRONIC DEVICES,Health economics,Follow-up,Devices,Remote monitoring,Implantable cardioverter defibrillator},
  language     = {eng},
  number       = {3},
  pages        = {158--169},
  title        = {EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): a provider perspective in five European countries on costs and net financial impact of follow-up with or without remote monitoring},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehu339},
  volume       = {36},
  year         = {2015},
}

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