Newcard telemonitoring system improves survival at a lower cost than traditional approaches in chronic heart failure patients as assessed by data extract from the French National Health Data System
Authors: Pathak A , Roubille F , Galinier M , Damy T , De Groote P , Mouquet F , Chatellier G , Levy P , Perrard G , Perrard L , Schmidt A 
Published: November 2023

Abstract

Background
Despite widespread use of telemonitoring (TLM) for chronic heart failure (CHF) patients, outcome data remain scarce and medico – economic assessment not routinely addressed. In this setting, the French National Health Data System (SNDS) can be used to comprehensively collect health care costs for the entire French population whatever the type of TLM system.

Purpose
The aim of this study is to assess the health economic impact of telemonitoring among 1057 patients presenting heart failure matched with a control group selected in the SNDS

Methods
All patients TLM at least 3 months between 2017 and 2020 were included. For each patient identified by his single social security number (case), anonymised data was retrieved from the SNDS. A control group (CG) was randomly selected from an exhaustive extraction of SNDS of patients with heart failure without TLM. This CG was matched in a 1:3 ratio to TLM patients using a propensity score including baseline characteristics (i.e. gender, age group, social disadvantage index, presence of comorbidities (renal insufficiency, coronary disease, diabetes, cancer), presence of treatments (beta blockers, Sacubitril, aldosterone antagonists, aspirin/Clopidogrel, anticoagulants)). Costs were evaluated using French National Health Insurance perspective using €2022. Binomial negative GEE models were used on matched data sets to assess differences.

Results
The matching rate between patients included in the TLM arm and the SNDS database was excellent at 99%. Hence, 1,057 TLM patients were matched to 3,171 patients with heart failure.
In the telemonitoring group (TLM), patients were 74 years old (±12,3), 68.4 % male, mean left ventricular ejection fraction 41 % and the mean follow-up by the TLM system was 618 days.
At 1-year, 2-year and 3-year follow-up, survival rates were respectively of 96%, 91% and 87% for TLM patients vs 93%, 83% and 76% among CG patients (p&lt;0.0001, figure 1).
At 6 months, the monthly cost for managing patients was 1,403.2 € in the TLM group vs 1,251.5 € in the CG (p=0.0064). At 12 months, 949.52 € in the TLM group vs 1,114.40 in the CG (p&lt;0.0001). At 24 months, 591.31 € in the TLM group vs 1,064.20 in the CG (p&lt;0.0001).

Conclusion
While using common evaluation methods seems to be unsatisfactory, economic evaluation both costs and outcomes of an intervention could be more appropriate. The French SNDS is a powerful tool to implement such a type of study. The results presented here show on one hand a significant decrease in mortality in the TLM. On the economic hand, we show here an increase in cost during the first 6 months of the telemonitoring balanced with a significant decrease at 12 and 24 months. Especially, those data place telemonitoring of heart failure as a real improvement in the care pathway which needs time to be effective but is able to have an effect even on the mortality rate