背景:使用心脏可植入电子设备(CIED)对患者进行远程监护可以改善其护理管理。然而,成本效益研究的结果是不同的。因此,远程监控是否值得投资仍是一个争论的问题。
目的:本系统综述旨在调查CIED远程监护患者的成本效益,专注于其关键驱动因素,以及不同观点的影响。
方法:在PubMed,WebofScience,Embase,还有EconLit.搜索于2022年7月7日完成。如果符合以下标准,则纳入研究:患者患有aCIED,与标准护理相比,并纳入健康经济评估(例如,成本效益分析和成本效用分析)。仅包括完整和同行评审的研究,并且没有应用年份限制。排除标准包括部分经济评估的研究,系统审查或报告,和没有标准护理的研究作为对照组。除了一般的研究特点,提取了以下结果指标:对总成本或收入的影响,成本或收入驱动因素,每位患者的成本或收入驱动因素,成本或收入驱动因素占总成本影响的百分比,增量成本效益比,或成本效用比。使用共识健康经济标准检查表评估质量。
结果:总体而言,包括15项成本效益分析。所有研究都是在西方国家进行的,主要是欧洲,主要是男性参与者。在15项研究中,3(20%)计算了增量成本效益比,1(7%)的成本效用比,和11(73%)远程监护对健康和成本的影响。总的来说,73%(11/15)的研究表明,对植入心脏复律除颤器(ICD)和心脏再同步治疗ICD的患者进行远程监护具有成本效益和成本节约,从医疗保健和患者的角度来看。对起搏器患者进行远程监测的成本效益结果尚无定论。从医疗保健的角度来看,降低成本的关键驱动因素是住院和定期的办公室就诊。住院费用每年每位患者减少912美元。预定的办公室访问占总成本减少的61%。从患者的角度来看,降低成本的关键驱动因素是收入损失,定期办公室访问和运输的费用。最后,在15项研究中,8人(52%)报告生活质量得到改善,仅在1项(13%)研究中具有统计学意义(P=0.03)。
结论:从医疗保健和患者的角度来看,对ICD或心脏再同步治疗ICD的患者进行远程监护是标准治疗的一种经济有效且节省成本的替代方案.发现起搏器患者的结果不确定。然而,远程监控会导致提供者收入的减少,主要是由于缺乏报销。引入适当的报销可以使远程监护对于提供者来说是可持续的,同时从医疗保健支付者的角度来看仍然具有成本效益。
背景:PROSPEROCRD42022322334;https://tinyurl.com/puunapdr。
BACKGROUND: Telemonitoring patients with cardiac implantable electronic devices (CIEDs) can improve their care management. However, the results of cost-effectiveness studies are heterogeneous. Therefore, it is still a matter of debate whether telemonitoring is worth the investment.
OBJECTIVE: This systematic
review aims to investigate the cost-effectiveness of telemonitoring patients with CIEDs, focusing on its key drivers, and the impact of the varying perspectives.
METHODS: A systematic
review was performed in PubMed, Web of Science, Embase, and EconLit. The search was completed on July 7, 2022. Studies were included if they fulfilled the following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations (eg, cost-effectiveness analyses and cost-utility analyses). Only complete and peer-reviewed studies were included, and no year limits were applied. The exclusion criteria included studies with partial economic evaluations, systematic reviews or reports, and studies without standard care as a control group. Besides general study characteristics, the following outcome measures were extracted: impact on total cost or income, cost or income drivers, cost or income drivers per patient, cost or income drivers as a percentage of the total cost impact, incremental cost-effectiveness ratios, or cost-utility ratios. Quality was assessed using the Consensus Health Economic Criteria checklist.
RESULTS: Overall, 15 cost-effectiveness analyses were included. All studies were performed in Western countries, mainly Europe, and had primarily a male participant population. Of the 15 studies, 3 (20%) calculated the incremental cost-effectiveness ratio, 1 (7%) the cost-utility ratio, and 11 (73%) the health and cost impact of telemonitoring. In total, 73% (11/15) of the studies indicated that telemonitoring of patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy ICDs was cost-effective and cost-saving, both from a health care and patient perspective. Cost-effectiveness results for telemonitoring of patients with pacemakers were inconclusive. The key drivers for cost reduction from a health care perspective were hospitalizations and scheduled in-office visits. Hospitalization costs were reduced by up to US $912 per patient per year. Scheduled in-office visits included up to 61% of the total cost reduction. Key drivers for cost reduction from a patient perspective were loss of income, cost for scheduled in-office visits and transport. Finally, of the 15 studies, 8 (52%) reported improved quality of life, with statistically significance in only 1 (13%) study (P=.03).
CONCLUSIONS: From a health care and patient perspective, telemonitoring of patients with an ICD or a cardiac resynchronization therapy ICD is a cost-effective and cost-saving alternative to standard care. Inconclusive results were found for patients with pacemakers. However, telemonitoring can lead to a decrease in providers\' income, mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers while still being cost-effective from a health care payer perspective.
BACKGROUND: PROSPERO CRD42022322334; https://tinyurl.com/puunapdr.