Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Duke Clinical Research Institute, Duke University, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
Heart Rhythm. 2023 Mar;20(3):440-447. doi: 10.1016/j.hrthm.2022.12.003. Epub 2022 Dec 8.
Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing nonactionable patient encounters.
The purpose of this study was to conduct a cost-consequence analysis to compare 3 postimplant implantable cardioverter-defibrillator (ICD) follow-up strategies: (1) in-person evaluation (IPE) only; (2) RPM-conventional (hybrid of IPE and RPM); and (3) RPM-alert (alert-based ICD follow-up).
We constructed a decision-analytic Markov model to estimate the costs and benefits of the 3 strategies over a 2-year time horizon from the perspective of the US Medicare payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) randomized clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of nonactionable encounters. Cost data were obtained from the published literature. The primary outcome was incremental cost.
Mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval [CI] -$2138 to +$638) and -$1,677 (95% CI -$3134 to -$304), respectively. Therefore, the RPM-alert strategy was most cost-effective, with an estimated cost-savings in 99% of simulations.
Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to those of conventional RPM, may be the preferred strategy for ICD follow-up.
基于警报的远程患者监测（RPM）或完全虚拟护理而无需常规评估，可能会减少诊所工作量并促进更有效的资源分配，主要是通过减少无行动的患者就诊。
本研究旨在进行成本效益分析，以比较 3 种植入式心律转复除颤器（ICD）植入后的随访策略：（1）仅进行门诊评估（IPE）；（2）RPM-常规（IPE 和 RPM 的混合）；（3）RPM-警报（基于警报的 ICD 随访）。
我们构建了一个决策分析马尔可夫模型，从美国医疗保险支付者的角度估算了这 3 种策略在 2 年时间范围内的成本和效益。TRUST（Lumos-T Safely RedUceS RouTine Office Device Follow-up）随机临床试验的综合和患者水平数据为临床有效性模型输入提供了信息。TRUST 将 1339 名患者以 2:1 的比例随机分为常规 RPM 或 IPE 组，发现 RPM 是安全的，并且减少了无行动的就诊次数。成本数据来自已发表的文献。主要结果是增量成本。
IPE 组每位患者的累积随访成本为 12688 美元，RPM-常规组为 12001 美元，RPM-警报组为 11011 美元。与 IPE 组相比，RPM-常规组和 RPM-警报组的增量成本分别降低了-687 美元（95%置信区间[-2138，638]）和-1677 美元（95%置信区间[-3134，-304]），因此具有统计学意义。因此，RPM-警报策略最具成本效益，在 99%的模拟中估计节省成本。
基于警报的 RPM 具有吸引力，如果患者的结局和安全性与常规 RPM 相当，则可能是 ICD 随访的首选策略。
