Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg Oest, Denmark.
Aarhus Business School, Aarhus University, Aarhus, Denmark.
BMJ Open. 2020 Jan 27;10(1):e031670. doi: 10.1136/bmjopen-2019-031670.
This study aimed to assess the cost-effectiveness of telehealthcare in heart failure patients as add-on to usual care.
A cost-utility analysis was conducted from a public payer perspective alongside the randomised controlled TeleCare North trial.
The North Denmark Region, Denmark.
The study included 274 heart failure patients with self-reported New York Heart Association class II-IV.
Patients in the intervention group were provided with a Telekit consisting of a tablet, a digital blood pressure monitor, and a scale and were instructed to perform measurements one to two times a week. The responsibility of the education, instructions and monitoring of the heart failure (HF) patients was placed on municipality nurses trained in HF and telemonitoring. Both groups received usual care.
Cost-effectiveness was reported as incremental net monetary benefit (NMB). A micro-costing approach was applied to evaluate the derived savings in the first year in the public health sector. Quality-adjusted life-years (QALY) gained were estimated using the EuroQol 5-Dimensions 5-Levels questionnaire at baseline and at a 1-year follow-up.
Data for 274 patients were included in the main analysis. The telehealthcare solution provided a positive incremental NMB of £5164. The 1-year adjusted QALY difference between the telehealthcare solution and the usual care group was 0.0034 (95% CI: -0.0711 to 0.0780). The adjusted difference in costs was -£5096 (95% CI: -8736 to -1456) corresponding to a reduction in total healthcare costs by 35%. All sensitivity analyses showed the main results were robust.
The TeleCare North solution for monitoring HF was highly cost-effective. There were significant cost savings on hospitalisations, primary care contacts and total costs.
ClinicalTrials.gov: NCT02860013.
本研究旨在评估心力衰竭患者远程医疗作为常规护理的附加治疗的成本效益。
从公共支付者的角度，对随机对照的 TeleCare North 试验进行成本效用分析。
丹麦北丹麦地区。
研究包括 274 名自我报告纽约心脏协会心功能分级 II-IV 级的心力衰竭患者。
干预组患者提供了一个 Telekit，其中包括一个平板电脑、一个数字血压计和一个秤，并被指示每周进行一到两次测量。对心力衰竭患者的教育、指导和监测的责任由接受过心力衰竭和远程监测培训的市立护士承担。两组均接受常规护理。
成本效益以增量净货币效益（NMB）报告。应用微观成本法评估公共卫生部门第一年节省的费用。使用 EuroQol 5-Dimensions 5-Levels 问卷在基线和 1 年随访时评估获得的调整后的生命质量调整年（QALY）。
TeleCare North 心力衰竭监测解决方案具有高度的成本效益。住院、初级保健接触和总医疗费用显著节省。
