Buchta Piotr, Tajstra Mateusz, Kurek Anna, Skrzypek Michał, Świetlińska Małgorzata, Gadula-Gacek Elżbieta, Wasiak Michał, Pyka Łukasz, Gąsior Mariusz
Third Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland, Poland.
Kardiol Pol. 2017;75(6):573-580. doi: 10.5603/KP.a2017.0019. Epub 2017 Feb 2.
The population of patients with implanted cardioverter-defibrillators (ICD) and cardiac resynchronisation therapy devices (CRT-D) is constantly growing. The use of remote-monitoring (RM) techniques in this group can significantly improve clinical outcomes, but there are limited data about the impact of RM on healthcare costs from a payer's perspective.
The aim of the study was to assess the impact on costs for the healthcare system of RM in patients with ICD or CRT-D.
We examined a cohort of 842 patients with ICD or CRT-D. The group was divided into two groups based on RM (or no RM [NRM]), matched according to important clinical characteristics. The subjects were followed for a maximum of three years after implantation (mean follow-up 2.11 ± 0.83 years). The overall costs for the healthcare provider in the follow-up were defined as the primary endpoint. The secondary endpoint was the use of different types of medical contact events: hospitalisation and number of in-clinic and general practitioner visits (without the number of remote transmissions).
In the three-year follow-up, the reduction in the costs of treatment for National Health Care in the RM group was 33.5% (median value, p < 0.001). In patients with implanted CRT-D, the reduction reached 42.7% (p = 0.011), and with ICD it was 31.3% (p = 0.007). We observed no significant reduction in the median hospitalisation costs in the three-year follow-up in the RM group (p = NS), despite a 25% drop in the mean value. The costs of outpatient visits were slightly higher in the RM group (p = NS). In the follow-up period, there was no reduction in the number of medical contact events (p = NS).
Remote monitoring in patients with implanted ICD or CRT-D devices reduces the cost for the national healthcare provider.
植入式心脏复律除颤器（ICD）和心脏再同步治疗设备（CRT-D）的患者群体在不断扩大。在这一群体中使用远程监测（RM）技术可显著改善临床结局，但从支付方角度来看，关于RM对医疗成本影响的数据有限。
本研究旨在评估RM对ICD或CRT-D患者医疗系统成本的影响。
我们研究了842例ICD或CRT-D患者队列。根据是否进行RM（或无RM [NRM]）将该组分为两组，并根据重要临床特征进行匹配。受试者在植入后最多随访三年（平均随访2.11±0.83年）。将随访期间医疗服务提供者的总体成本定义为主要终点。次要终点是不同类型医疗接触事件的使用情况：住院以及门诊和全科医生就诊次数（不包括远程传输次数）。
在三年随访中，RM组国家医疗保健治疗成本降低了33.5%（中位数，p<0.001）。在植入CRT-D的患者中，成本降低达到42.7%（p = 0.011），在ICD患者中为31.3%（p = 0.007）。尽管RM组三年随访中的住院成本中位数没有显著降低（p =无显著性差异），但其平均值下降了25%。RM组门诊就诊成本略高（p =无显著性差异）。在随访期间，医疗接触事件的数量没有减少（p =无显著性差异）。
对植入ICD或CRT-D设备的患者进行远程监测可降低国家医疗服务提供者的成本。
