Management Unit, Hospital de Poniente, El Ejido, Almeria, Spain.
Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, El Ejido, s/n, 04700, Almeria, Spain.
BMC Geriatr. 2020 Nov 16;20(1):474. doi: 10.1186/s12877-020-01883-3.
Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of older patients with pacemakers, 5 years after implant.
Under a controlled, not randomized, nor masked clinical trial, 83 patients with pacemakers were initially selected. After five years of follow-up, a total of 55 patients (CM = 34; RM = 21) completed the study. A cost-utility analysis of RM in terms of costs per gained quality-adjusted life years (QALYs) was conducted. The costs from the Public Health System (PHS) as well as patients and their relatives were taken into account for the study. The robustness of the results was verified by the probabilistic analyses through Monte-Carlo simulations.
After a five-year follow-up period, total costs were lower in the RM group by 23.02% than in the CM group (€274.52 versus €356.62; p = 0.033) because of a cost saving from patients' perspective (€59.05 versus €102.98; p = 0.002). However, the reduction of in-hospital visits derived from RM exhibited insignificant impact on the costs from the PHS perspective, with a cost saving of 15.04% (€215.48 vs. €253.64; p = 0.144). Costs/QALYs obtained by the RM group were higher as compared to the CM group, although there were no significant differences. The incremental cost-effectiveness ratio of CM in comparison to RM became positive (€301.16).
This study confirms RM of older patients with pacemakers appears still as a cost-utility alternative to CM in hospital after 5 years of follow-up.
ClinicalTrials.gov: (Identifier: NCT02234245 ). Registered 09 September 2014 - Prospectively registered.
近年来，起搏器的成本效益研究有所增加。然而，长期成本效用研究的数量有限。本研究的目的是对植入后 5 年的老年起搏器患者进行远程监测（RM）与常规监测（CM）的成本效用分析。
在一项对照、非随机、非盲临床试验中，最初选择了 83 名起搏器患者。经过 5 年的随访，共有 55 名患者（CM=34；RM=21）完成了研究。对 RM 的成本效用进行了分析，根据获得的每单位质量调整生命年（QALY）的成本进行了分析。该研究考虑了公共卫生系统（PHS）以及患者及其家属的成本。通过蒙特卡罗模拟的概率分析验证了结果的稳健性。
在 5 年的随访期间，RM 组的总费用比 CM 组低 23.02%（€274.52 比 €356.62；p=0.033），因为从患者角度来看，节省了 59.05 欧元（€102.98；p=0.002）。然而，RM 减少的住院就诊次数对 PHS 角度的成本没有显著影响，节省了 15.04%（€215.48 比 €253.64；p=0.144）。RM 组获得的成本/QALY 高于 CM 组，但差异无统计学意义。CM 与 RM 相比的增量成本效益比为正（€301.16）。
这项研究证实，植入后 5 年，对老年起搏器患者进行 RM 仍然是 CM 医院监测的一种具有成本效益的替代方案。
ClinicalTrials.gov：（标识符：NCT02234245）。2014 年 9 月 9 日注册-前瞻性注册。
