目的:心力衰竭(HF)是一种复杂的临床综合征,死亡率和住院率很高。非侵入性远程患者监测(RPM)干预具有防止疾病恶化的潜力。然而,RPM的长期成本效益尚不清楚。这项研究旨在评估荷兰(NL)RPM的成本效益,英国(UK),和德国(DE)从社会和医疗保健的角度强调了成本效益之间的差异。
方法:我们开发了具有生命周期的马尔可夫模型,以评估RPM与常规护理相比的成本效益。我们包括HF相关的住院和非住院费用,干预成本,其他医疗费用,非正式护理费用,以及非医疗消费的成本。进行了概率敏感性分析和情景分析。
结果:RPM降低了与HF相关的住院费用,但与常规治疗相比,这三个国家的终生总费用均较高.估计的增量成本效益比(ICER),从社会的角度来看,NL为27,921欧元,32,263欧元和35,258欧元,英国,分别为DE。荷兰ICER较低的主要原因是医院外的非医疗消费成本和HF相关成本较低。ICER,从医疗保健的角度来看,NL为12,977欧元,11,432欧元和11,546欧元,英国,和DE,分别。ICER对RPM的有效性和效用值最敏感。
结论:这项研究表明,从医疗保健和社会角度来看,用于HF的RPM具有成本效益。包括更长的生活费用,例如非正式护理和非医疗消费,增加了ICER。
OBJECTIVE: Heart failure (HF) is a complex clinical syndrome with high mortality and hospitalization rates. Non-invasive remote patient monitoring (RPM) interventions have the potential to prevent disease worsening. However, the long-term cost-effectiveness of RPM remains unclear. This study aimed to assess the cost-effectiveness of RPM in the Netherlands (NL), the United Kingdom (UK), and Germany (DE) highlighting the differences between cost-effectiveness from a societal and healthcare perspective.
METHODS: We developed a Markov model with a lifetime horizon to assess the cost-effectiveness of RPM compared with usual care. We included HF-related hospitalization and non-hospitalization costs, intervention costs, other medical costs, informal care costs, and costs of non-medical consumption. A probabilistic sensitivity analysis and scenario analyses were performed.
RESULTS: RPM led to reductions in HF-related hospitalization costs, but total lifetime costs were higher in all three countries compared to usual care. The estimated incremental cost-effectiveness ratios (ICERs), from a societal perspective, were €27,921, €32,263, and €35,258 in NL, UK, and DE respectively. The lower ICER in the Netherlands was mainly explained by lower costs of non-medical consumption and HF-related costs outside of the hospital. ICERs, from a healthcare perspective, were €12,977, €11,432, and €11,546 in NL, the UK, and DE, respectively. The ICER was most sensitive to the effectiveness of RPM and utility values.
CONCLUSIONS: This study demonstrates that RPM for HF can be cost-effective from both healthcare and societal perspective. Including costs of living longer, such as informal care and non-medical consumption during life years gained, increased the ICER.