Background
Alert-driven remote patient monitoring (RPM) or fully virtual care without routine
evaluations may reduce clinic workload and promote more efficient resource allocation,
principally by diminishing nonactionable patient encounters.
Objective
The purpose of this study was to conduct a cost–consequence analysis to compare 3
postimplant implantable cardioverter-defibrillator (ICD) follow-up strategies: (1)
in-person evaluation (IPE) only; (2) RPM–conventional (hybrid of IPE and RPM); and
(3) RPM–alert (alert-based ICD follow-up).
Methods
We constructed a decision-analytic Markov model to estimate the costs and benefits
of the 3 strategies over a 2-year time horizon from the perspective of the US Medicare
payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine
Office Device Follow-up) randomized clinical trial informed clinical effectiveness
model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone,
and found that RPM was safe and reduced the number of nonactionable encounters. Cost
data were obtained from the published literature. The primary outcome was incremental
cost.
Results
Mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001
in the RPM–conventional group, and $11,011 in the RPM–alert group. Compared to the
IPE group, both the RPM–conventional and RPM–alert groups were associated with lower
incremental costs of –$687 (95% confidence interval [CI] –$2138 to +$638) and –$1,677
(95% CI –$3134 to –$304), respectively. Therefore, the RPM–alert strategy was most
cost-effective, with an estimated cost-savings in 99% of simulations.
Conclusions
Alert-driven RPM was economically attractive and, if patient outcomes and safety are
comparable to those of conventional RPM, may be the preferred strategy for ICD follow-up.
Keywords
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Article info
Publication history
Published online: December 07, 2022
Footnotes
Funding Sources: Dr Piccini is supported by R01AG074185 from the National Institutes of Aging.
Disclosures: Dr Piccini receives grants for clinical research from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips; and serves as a consultant to Abbott, Abbvie, Ablacon, Altathera, ARCA biopharma, Bayer, Biotronik, Boston Scientific, Bristol Myers Squibb (Myokardia), Element Science, Itamar Medical, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, ReCor, Sanofi, Philips, and Up-to-Date outside of the submitted work. Mr Michalski is an employee of Biotronik. Dr Varma is a consultant/speaker for Abbott, Medtronic, Biotronik, Impulse Dynamics, and Boston Scientific. All other authors have no conflicts of interest to disclose. ClinicalTrials.gov Identifier: NCT00336284.
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