[Economic evaluation of a telemonitoring intervention from primary care in home care patients with cardiac insufficiency and/or chronic bronchial disorders: Cost-effectiveness analysis, TELBIL study]

Bayón JC, Martín I, Cairo MC, Orruño E, Asua J, Romo MI, Abad R, Reviriego E, Bilbao A, Vergara I, Larrañaga J
Record ID 32018000582
Original Title: Evaluación económica de una intervención de telemonitorización desde la atención primaria en pacientes domiciliarios con insuficiencia cardiaca y/o broncopatía crónica: Análisis coste-efectividad. Estudio TELBIL
Authors' objectives: Carry out an economic evaluation, cost-effectiveness analysis, in which a telemonitoring intervention by primary care in home care patients with cardiac insufficiency and/or chronic bronchial disorders is compared with the normal treatment procedure of these patients.
Authors' results and conclusions: The cost-effectiveness analysis showed that the telemonitoring intervention from primary care in home care patients with cardiac insufficiency and/or bronchial disorders was cheaper (-2,230.63€ (IC at 95%: -24,532.86€ to 11,290.04€)) and more effective (0.06415 QALY (IC at 95%: -0.14023 QALY at 0.26758 QALY)) compared with the customary procedure used for treating the same patients. The ICER obtained was -34,772.10 €/QALY (IC at 95%: -564,059.01 €/QAYL to 1,200,111.36 €/QALY. The cost efficiency acceptability curve indicated that for an acceptability threshold of 20,000 €/ QALY the probability of the telemonitoring procedures being cost-effective would be 60.2%, increasing to 63.3% and 72.4% for threshold of 30,000 €/QALY and 120,000 €/QALY, respectively. Discussion For the sample of patients taking part in the trial, the determining results of the cost-effectiveness analysis showed that the telemonitoring procedure by primary care in home care patients with cardiac insufficiency and/or chronic bronchial disorders is less costly and more effective than the customary treatment procedure. However, from the confidence interval calculated for the ICER, a high level of variability and therefore uncertainty is deduced when taking decisions on the basis of the calculated ICER. It is considered advisable to examine more closely the strategy defined in this study through further studies that will allow improvements to be made in the models and a comparison of the results obtained.
Authors' methods: The economic evaluation and cost-effectiveness analysis were carried out based on the controlled and randomised clinical tests performed at Primary Care Health Centres in the Bilbao region of Osakidetza, the «TELBIL study», the main characteristics of which are described in the protocol published in the BMC Health Services Research. The standpoint adopted in the analysis was that of the institution that finances the technology (Department of Health of the Autonomous Community of the Basque Country), the time horizon was one year and neither costs nor results were discounted. The results were measured in Quality-Adjusted Life-Years (QALY), which were calculated based on the data obtained from the generic questionnaire on quality of life EQ-5D. The QALY calculation was carried out using the «area under the curve» method and by means of multiple linear regression, the imbalance in the mean basal utility was controlled. Finally, the mean QALY was calculated for the procedures. As a consequence of the standpoint adopted for the study, only the direct costs of the procedures under study were evaluated, i.e., the costs directly associated with the telemonitoring intervention and those associated with this, for both procedures, with home care and the impact on the consumption of the health resources required. The unitary costs were calculated per patient and to do this the health resources consumed and the average costs for each procedure were identified, measured and valued (in 2010 euros). In order to determine whether the telemonitoring intervention is more cost-effective than the customary procedure, the Incremental Cost-Effectiveness Ratio (ICER) was calculated as the quotient between the average incremental cost and the average incremental effectiveness. Using the nonparametric bootstrapping method, the uncertainty of the ICER due to the variability of the sample was analysed. The uncertainty that arises in the decision with respect to the cost-effectiveness relationship of the telemonitoring intervention was reflected by means of the cost-effectiveness acceptability curve.
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Other
Country: Spain
MeSH Terms
  • Telemedicine
  • Home Care Services
  • Heart Failure
  • Bronchial Diseases
  • Asthma
  • Cost-Benefit Analysis
  • Telenursing
  • Chronic Disease
  • Primary Health Care
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Economics
  • Telemedicine
  • Home Care Services
  • Heart Failure
  • Bronchial Diseases
  • Enfermedades Bronquiales
  • Insuficiencia Cardíaca
  • Servicios de Atención de Salud a Domicilio
  • Telemedicina
  • Economía
  • Costos y Análisis de Costo
  • Análisis Costo-Beneficio
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: Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government
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