Cost–utility analysis of remote versus conventional monitoring of pacemakers in the Arctic Circle

• Published in: European Journal of Public Health
• Main Authors: Lopez-Villegas, A, Catalan-Matamoros, D, Peiro, S, Lappegard, K T, Lopez-Liria, R
• Format: Article in Journal/Newspaper
• Language: English
• Published: Oxford University Press (OUP) 2020
• Subjects: Public Health, Environmental and Occupational Health; Arctic
• Online Access: http://dx.doi.org/10.1093/eurpub/ckaa166.572; http://academic.oup.com/eurpub/article-pdf/30/Supplement_5/ckaa166.572/33819325/ckaa166.572.pdf

Abstract Introduction Several studies have demonstrated that remote monitoring (RM) of pacemakers is safe, effective and cost-saving. The aim of this study was to perform an economic assessment and check whether RM offers a cost-utility alternative to conventional monitoring in hospital (CM). Methods This is a controlled, randomized, non-masked clinical trial. Fifty patients with pacemaker were assigned to receive either RM (n = 25) or CM (n = 25). Data were collected during the 12 months. A cost-utility analysis was performed in order to assess whether RM of pacemakers is cost-effective compared to CM in hospital in terms of costs per gained quality-adjusted life years (QALY). The analysis was performed from the perspectives of the Norwegian Healthcare System (NHS) and patients. Results Overall, total costs from the NHS perspective were higher in the RM group (€2,079.84 vs. €271.97; p = 0.147). The costs related to the patients perspective were higher in the RM than those in the CM group (€223.99 vs. €158.42, respectively; P = 0.429). Patients included in the CM obtained 0.04 QALYs less than those in the RM group over 12 months and the total costs per QALY comprised €1,784.10 (P = 0.175) per user with a pacemaker implant. The total number of pacemaker transmissions per patient year comprised 86.46% of minors in the CM group. Conclusions The follow-up costs were similar between both groups. Cost-utility analysis showed broad confidence intervals with ICERs ranging from potential savings to high costs for an additional QALY, with most ICERs lower than the usual NHS thresholds for coverage decisions. Key messages Total costs from the National Health System perspective were higher in the remote monitoring group, although there were not significant differences between both groups of follow-up. The costs related to the patient perspective were higher in the remote monitoring than those in the conventional monitoring group, without significant differences.