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 ) .
Cost-effectiveness of telephonic disease management in heart failure.
OBJECTIVE To evaluate the cost-effectiveness of a telephonic disease management ( DM ) intervention in heart failure ( HF ) . STUDY DESIGN R and omized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF ( SHF ) and diastolic HF performed between 1999 and 2003 . The enrollment period was 18 months per subject . METHODS Bootstrap-re sample d incremental cost-effectiveness ratios ( ICERs ) were computed and compared across groups . Direct medical costs were obtained from a medical record review that collected records from 92 % of patients ; 66 % of records requested were obtained . RESULTS Disease management produced statistically significant survival advantages among all patients ( 17.4 days , P = .04 ) , among patients with New York Heart Association ( NYHA ) class III/IV symptoms ( 47.7 days , P = .02 ) , and among patients with SHF ( 24.2 days , P = .01 ) . Analyses of direct medical and intervention costs showed no cost savings associated with the intervention . For all patients and considering all-cause medical care , the ICER was $ 146 870 per quality -adjusted life-year ( QALY ) gained , while for patients with NYHA class III/IV symptoms and patients with SHF , the ICERs were $ 67 784 and $ 95 721 per QALY gained , respectively . Costs per QALY gained were $ 101 120 for all patients , $ 72 501 for patients with SHF , and $ 41 348 for patients with NYHA class III/IV symptoms . CONCLUSIONS The intervention was effective but costly to implement and did not reduce utilization . It may not be cost-effective in other broadly representative sample s of patients . However , with program cost reductions and proper targeting , this program may produce life-span increases at costs that are less than $ 100 000 per QALY gained
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 ) .