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 ) .
Long-Term Healthcare and Cost Outcomes of Disease Management in a Large, Randomized, Community-Based Population With Heart Failure
Background —Because of the prevalence and expense of congestive heart failure ( CHF ) , significant efforts have been made to develop disease management ( DM ) programs that will improve clinical and financial outcomes . The effectiveness of such programs in a large , heterogeneous population of CHF patients remains unknown . Methods and Results —We r and omized 1069 patients ( aged 70.9±10.3 years ) with systolic ( ejection fraction 35±9 % ) or echocardiographically confirmed diastolic heart failure ( HF ) to assess telephonic DM over an 18-month period . Data were collected at baseline and at 6-month intervals . Survival analysis was performed by Kaplan-Meier and Cox regression methods . Healthcare utilization was defined after extensive record review , with an attempt to account for all inpatient and outpatient visits , medications , and diagnostic tests . We obtained data on 92 % of the patients , from nearly 53 000 health-related encounters . Total cost per patient was defined by adding estimated costs for the observed encounters , excluding the cost of the DM . Kaplan-Meier analysis showed that DM patients had a reduced mortality rate ( P=0.037 ) , with DM patients surviving an average of 76 days longer than controls . Subgroup analysis showed that DM had beneficial outcomes in patients with systolic HF ( hazard ratio 0.62 ; P=0.040 ) , which was more pronounced in NYHA classes III and IV . Although improvements in NYHA class were more likely with DM ( P<0.001 ) , 6-minute walk data from 217 patients in whom data were available at each visit showed no significant benefit from DM ( P=0.08 ) . Total and CHF-related healthcare utilization , including medications , office or emergency department visits , procedures , or hospitalizations , was not decreased by DM . Repeated- measures ANOVA for cost by group showed no significant differences , even in the higher NYHA class groups . Conclusions —Participation in DM result ed in a significant survival benefit , most notably in symptomatic systolic HF patients .  Although DM was associated with improved NYHA class , 6-minute walk test results did not improve . Healthcare utilization was not reduced by DM , and it conferred no cost savings . DM in HF results in improved life expectancy but does not improve objective measures of functional capacity and does not reduce cost
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 ) .