No favourable effect on mortality was observed with STS HM .
Similar reductions were observed in all-cause hospitalisations for TM interventions , whereas STS interventions had no major effect .
STS HM was dominated by usual care .
Similar results were observed in scenario analyses performed using higher costs of usual care , higher costs of STS HH and lower costs of TM during office hours .
As a result , the economic model developed scenarios for different RM classifications and their costs were estimated using bottom-up costing methods .
Despite wide variation in usual care and RM strategies , cost-effectiveness analyses suggest that TM during office hours was an optimal strategy ( in most costing scenarios ) .
However , clarity was lacking among descriptions of the components of RM packages and usual care and there was a lack of robust estimation of costs .
BACKGROUND Remote monitoring ( RM ) strategies have the potential to deliver specialised care and management to patients with heart failure ( HF ) .
OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of home telemonitoring ( TM ) or structured telephone support ( STS ) strategies compared with usual care for adult patients who have been recently discharged ( within 28 days ) from acute care after a recent exacerbation of HF .
The review included r and omised controlled trials ( RCTs ) or observational cohort studies with a contemporaneous control group that included the following RM interventions : ( 1 ) TM ( including cardiovascular implanted monitoring devices ) with medical support provided during office hours or 24/7 ; ( 2 ) STS programmes delivered by human-to-human contact ( HH ) or human-to-machine interface ( HM ) .
Hospital cost effect of a heart failure disease management program: the Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) trial.
BACKGROUND Determine the effect on hospitalization cost of a heart failure disease management ( HFDM ) program delivered within a diverse provider network as demonstrated in the SPAN-CHF r and omized controlled trial . METHODS The SPAN-CHF trial was a prospect i ve r and omized assessment of the effectiveness of HFDM delivered for 90 days across a diverse provider network in a heterogeneous population of 200 patients . Baseline clinical and demographic data were obtained on each patient , mortality was monitored , and hospitalizations were tracked for 90 days . Cost estimates for each hospitalization were based on a sub sample of patients seen at Tufts-New Engl and Medical Center for whom hospitalization costs were calculated . Heart failure disease management program costs were estimated using a programmatic budget model . Hospital utilization and cost data were combined to estimate medical costs for intervention and control groups . RESULTS Heart failure disease management had a favorable effect on heart failure hospitalization , which was partially offset by noncardiac hospitalizations . The relative odds of at least one all-cause hospitalization during the intervention period trended less for the intervention group compared with the control group ( 0.76 [ 95 % CI 0.38 - 1.51 ] ) . The point estimate of the differential hospitalization cost between control and intervention groups was a reduction in cost of $ 375 per patient . The net effect including the costs of the program was an increase of $ 488 per patient for the intervention group compared with the control group . The program would have been cost saving if HFDM costs had been 24 % lower . CONCLUSION The HFDM intervention , administered over 90 days to patients hospitalized for heart failure , succeeded in reducing the rate of heart failure hospitalizations , although this effect was partially offset by an increase in non-heart failure hospitalizations . The result ing modest reduction in all-cause hospitalization costs was exceeded by the cost of the intervention . Thus , although the reduction in heart failure may be interpreted as an improvement in health status , it could not be considered cost saving
No favourable effect on mortality was observed with STS HM .
Similar reductions were observed in all-cause hospitalisations for TM interventions , whereas STS interventions had no major effect .
STS HM was dominated by usual care .
Similar results were observed in scenario analyses performed using higher costs of usual care , higher costs of STS HH and lower costs of TM during office hours .
As a result , the economic model developed scenarios for different RM classifications and their costs were estimated using bottom-up costing methods .
Despite wide variation in usual care and RM strategies , cost-effectiveness analyses suggest that TM during office hours was an optimal strategy ( in most costing scenarios ) .
However , clarity was lacking among descriptions of the components of RM packages and usual care and there was a lack of robust estimation of costs .
BACKGROUND Remote monitoring ( RM ) strategies have the potential to deliver specialised care and management to patients with heart failure ( HF ) .
OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of home telemonitoring ( TM ) or structured telephone support ( STS ) strategies compared with usual care for adult patients who have been recently discharged ( within 28 days ) from acute care after a recent exacerbation of HF .
The review included r and omised controlled trials ( RCTs ) or observational cohort studies with a contemporaneous control group that included the following RM interventions : ( 1 ) TM ( including cardiovascular implanted monitoring devices ) with medical support provided during office hours or 24/7 ; ( 2 ) STS programmes delivered by human-to-human contact ( HH ) or human-to-machine interface ( HM ) .