Original Title: Análisis coste-efectividad de una experiencia de telemonitorización en pacientes con insuficiencia cardiaca y enfermedad pulmonar obstructiva crónica

Authors' objectives: The aims of this study were as follows: assess the impact of a telemonitoring experiment on the use of health services and on the quality of life of patients with Cardiac Insufficiency (CI) and Chronic Obstructive Pulmonary Disease (COPD) and to perform an economic assessment (cost-effectiveness analysis) of this experiment.

Authors' results and conclusions: A statistically significant difference was observed between the MSIC+TE and the MSIC procedures in the hospital stay duration variable (incidence rates ratio 2.05 with a 95% CI of 1.61 to 2.63). The differences in the number of hospital admissions and emergency services visits were not statistically significant (incidence rates ratio 1.82 with a 95% CI of 0.99 to 3.37 and of 1.2 with a 95% CI of 0.72 to 2.09, respectively). Between the initial and final results of patients included in the MSIC+TE and MSIC procedures, no quality-of-life differences were observed. The statistical tests carried out with the health profile, health index and VAS score variables did not show any statistically significant differences. As a result of the cost-effectiveness analysis, the MSIC+TE was shown to be less costly, incremental cost equal to -4,781€ (95% CI: -4,908 to -4,662) and less effective, incremental effectiveness equal to -0.0414 (95% CI: -0.1783 to 0.0917) than the MSIC procedure. The incremental cost-effectiveness ratio (ICER) was equal to 115,569 €/QALY (95% CI: -951,909 to 748,696) for the MSIC procedure. Should the decider opt for the most effective procedure (MSIC), for a willingness to pay equal to or in excess of 140,000 €/ QALY, the likelihood of this being cost-effective would not be greater than 60%. Should he opt for the most economic, cost-saving option (MSIC+TE), this would be the option chosen with a likelihood of 100%.

Authors' methods: In order to assess the impact of telemonitoring on the use of health resources, we used data on hospital readmission variables, visits to A&E units and the duration of hospital stays gathered in a randomised clinical trial made at the Donostia hospital (Clinical Trials registration number ISRCTN62033748). The incidence rates were calculated for each variable studied, the differences between this and relative hazards, both for the MSIC (Multi Strategy of Individualised Care) and TE (telemonitoring) procedure (MSIC+TE) and for the MSIC procedure. The effect of telemonitoring on the quality of life of patients was based on data gathered by means of the EQ-5D generic questionnaire, validated for Spain. Thanks to the responses from patients taking part in the study, the following variables were obtained for each: a description of their state of health, a score based on a visual analogue scale (VAS) and a health or utility index. A descriptive analysis of these variables was made and the health profiles, health indices and VAS scores of patients controlled by multiple strategy individualised care and those controlled by means of MSIC and a telemonitoring system (MSIC+TE), both at the beginning and end of the test. A check was made of whether the differences observed in the quality of life of patients subjected to both procedures were statistically significant (a statistically significant value for p less than 0.05 was assumed), for which one or more of the following tests were used (depending on whether the variables were quantitative or qualitative): Chi-squared test, Fisher’s exact test, t-test measurement comparison test and Mann-Whitney nonparametric test. A cost-effectiveness analysis was carried out, in which the costs and benefits of MSIC+TE and MSIC procedures were compared. The data for calculating the analysis were obtained from this clinical trial. Effectiveness was measured in quality adjusted life years (QALYs). These were calculated from the data provided by the generic questionnaire EuroQol-5D (EQ-5D). Given the viewpoint of the entity that financed the health system adopted in the study, we calculated the direct costs involved in the procedures to be compared (specific costs of the telemonitoring programme, the cost of care brought about by telemonitoring and the cost of the impact of this on the use of health resources). Following the calculation of the QALYs and costs, the incremental cost-effectiveness ratio ICER was found. In order to check the uncertainty of the results, a sensitivity analysis was carried out. The statistical, nonparametric Bootstrap method was used.

Project Status: Completed

Year Published: 2012

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051044&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Other

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>