Original Title: Efectividad clínica y coste-efectividad de la telemonitorización noinvasiva en pacientes con insuficiencia cardiaca

Authors' objectives: 1. To analyse the scientific evidence about the clinical effectiveness of non-invasive telemonitoring of patients with heart failure (HF). 2. To analyse the scientific evidence about the cost-effectiveness of non-invasive telemonitoring of patients with HF.

Authors' results and conclusions: The results obtained from the meta-analysis suggested that in comparison to usual care, home telemonitoring interventions improve the rates of survival and reduce the risk of HF-related hospitalisations. Generally speaking, the favourable effects of remote monitoring found in the RCTs included in this review are based on low or moderate quality evidence. More research is required to determine what telemonitoring strategies give optimal results, in which circumstances and for what sub-group of patients, using a multi-disciplinary methodology that can elucidate the complex factors that have an influence on the effects of telemonitoring interventions. Telemonitoring of patients with HF appears to the most cost-effective intervention amongst the different interventions that were studied. It is necessary to carry out more complete economic assessment analyses based on analytical decision models that would enable drawing long term conclusions.

Authors' methods: The evidence of the effect of telemonitoring on mortality came from the meta-analysis carried out on 21 RCTs with a total of 5,755 patients with HF, where a statistically significant reduction of 20 % was observed in terms of the relative risk of mortality (RR 0.80; 95 % CI: 0.70 to 0.91; I2 =21 %; moderate-quality evidence). The risk of hospitalisations related to HF decreased by 30 % with telemonitoring interventions in comparison to usual care (RR 0,70; 95 % CI: 0.60 to 0.82; nine studies; 2,246 patients; I2 =10 %; moderate-quality evidence). Non-invasive telemonitoring had no significant effect on the risk of all-cause hospitalisations (RR 0.96; 95 % CI: 0.60 to 1.02; nine studies; 5,347 patients; I2 =69 %; low-quality evidence). Remote monitoring had a positive and significant effect on the overall quality of life when compared to standard care (SMD 0.34; 95 % CI: 0.05 to 0.63; gl=8; p=0.02; I2 =79 %; moderate-quality evidence). Three cost-effectiveness studies of moderate-high quality were included, which compared telemonitoring in patients with HF to usual care. According to the scientific literature, for patients with HF both home telemonitoring and structured human-to-human telephone support were considered cost-effective or dominant procedures when compared to usual care. The results of the sensitivity analyses, both univariate and scenario analysis, did not significantly alter the results obtained for the base case. CONCLUSIONS The objectives of the study were approached through systematic review (SR) of the scientific literature. The following data bases were searched: Medline (PubMed), Embase (OVID), Cochrane Library (Wiley), Cinahl (EbscoHost), CRD and DARE and the data bases of economic studies (NHS EED y HEED). The specialised journals Journal of Telemedicine and Telecare and Telemedicine and e-Health were searched. A manual scanning of reference lists from the included studies was carried out. For objective No. 1 high methodological quality SRs (with or without meta-analysis) that gave a response to the proposed research question were selected. Then the search for randomised controlled trials (RCTs) was updated, following the search strategy proposed in one of the SRs included. For objective No. 2 complete economic assessments were selected: cost-effectiveness, cost-utility, cost-benefit and cost-minimisation analyses. The methodological quality of the SRs included was assessed using the AMSTAR, for economic assessment studies the CHEERS check list was used and the internal validity of the RCTs was assessed using the Risk of Bias of the Cochrane Collaboration. The level of evidence was classified according to SIGN. Meta-analysis of the data was conducted to evaluate the clinical effectiveness.

Project Status: Completed

Year Published: 2017

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=052085&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>