Clinical Division of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria.
Clin Res Cardiol. 2024 Aug;113(8):1232-1241. doi: 10.1007/s00392-024-02395-5. Epub 2024 Feb 14.
This study aimed to assess the cost-effectiveness of the telemedically assisted post-discharge management program (DMP) HerzMobil Tirol (HMT) for heart failure (HF) patients in clinical practice in Austria.
We conducted a cost-effectiveness analysis along a retrospective cohort study (2016-2019) of HMT with a propensity score matched cohort of 251 individuals in the HMT and 257 in the usual care (UC) group and a 1-year follow-up. We calculated the effectiveness (hospital-free survival, hospital-free life-years gained, and number of avoided rehospitalizations), costs (HMT, rehospitalizations), and the incremental cost-effectiveness ratio (ICER). We performed a nonparametric sensitivity analysis with bootstrap sampling and sensitivity analyses on costs of HF rehospitalizations and on costs per disease-related diagnosis (DRG) score for rehospitalizations.
Base-case analysis showed that HMT resulted in an average of 42 additional hospital-free days, 40 additional days alive, and 0.12 avoided hospitalizations per patient-year compared with UC during follow-up. The average HMT costs were EUR 1916 per person. Mean rehospitalization costs were EUR 5551 in HMT and EUR 6943 in UC. The ICER of HMT compared to UC was EUR 4773 per life-year gained outside the hospital. In a sensitivity analysis, HMT was cost-saving when "non-HF related costs" related to the DMP were replaced with average costs.
The economic evaluation along the cohort study showed that the HerzMobil Tirol is very cost-effective compared to UC and cost-saving in a sensitivity analysis correcting for "non-HF related costs." These findings promote a widespread adoption of telemedicine-assisted DMP for HF.
本研究旨在评估远程医疗辅助出院后管理方案（DMP）HerzMobil Tirol（HMT）在奥地利临床实践中对心力衰竭（HF）患者的成本效益。
我们进行了一项成本效益分析，同时对 HMT 进行了回顾性队列研究（2016-2019 年），对 HMT 组的 251 名患者和常规护理（UC）组的 257 名患者进行了倾向评分匹配，并进行了为期 1 年的随访。我们计算了有效性（无住院生存率、无住院寿命增加和避免再住院的次数）、成本（HMT、再住院）和增量成本效益比（ICER）。我们进行了非参数敏感性分析，采用 bootstrap 抽样，并对 HF 再住院费用和再住院每疾病相关诊断（DRG）评分的费用进行了敏感性分析。
基础分析显示，与 UC 相比，在随访期间，HMT 使患者平均每年多获得 42 天的无住院天数、40 天的生存天数和 0.12 次避免住院治疗。HMT 的平均费用为每人 1916 欧元。HMT 组的平均再住院费用为 5551 欧元，UC 组为 6943 欧元。与 UC 相比，HMT 的增量成本效益比为每获得 1 年额外的无住院生存时间 4773 欧元。在敏感性分析中，当用 DMP 的平均费用替代与 DMP 相关的“非 HF 相关费用”时，HMT 具有成本效益。
队列研究中的经济评估表明，与 UC 相比，HerzMobil Tirol 非常具有成本效益，并且在敏感性分析中纠正了“非 HF 相关成本”后具有成本效益。这些发现促进了远程医疗辅助 DMP 在 HF 中的广泛应用。
