The Box-eHealth in the Outpatient Clinic Follow-up of Patients With Acute Myocardial Infarction: Cost-Utility Analysis

Roderick Willem Treskes, M Elske van den Akker-van Marle, Louise van Winden, Nicole van Keulen, Enno Tjeerd van der Velde, Saskia Beeres, Douwe Atsma, Martin Jan Schalij, Roderick Willem Treskes, M Elske van den Akker-van Marle, Louise van Winden, Nicole van Keulen, Enno Tjeerd van der Velde, Saskia Beeres, Douwe Atsma, Martin Jan Schalij

Abstract

Background: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care.

Objective: The primary purpose of this paper is to describe a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI).

Methods: In this trial, of which clinical results have been published previously, patients with an AMI were randomized in a 1:1 fashion between an eHealth intervention and regular follow-up. The remote monitoring intervention consisted of a blood pressure monitor, weight scale, electrocardiogram device, and step counter. Furthermore, two in-office outpatient clinic visits were replaced by e-visits. The control group received regular care. The differences in mean costs and quality of life per patient between both groups during one-year follow-up were calculated.

Results: Mean costs per patient were €2417±2043 (US $2657±2246) for the intervention and €2888±2961 (US $3175±3255) for the control group. This yielded a cost reduction of €471 (US $518) per patient. This difference was not statistically significant (95% CI -€275 to €1217; P=.22, US $-302 to $1338). The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference -0.05, 95% CI -0.09 to -0.01; P=.01).

Conclusions: eHealth in the outpatient clinic setting for patients who suffered from AMI is likely to be cost-effective compared to regular follow-up. Further research should be done to corroborate these findings in other patient populations and different care settings.

Trial registration: ClinicalTrials.gov NCT02976376; https://ichgcp.net/clinical-trials-registry/NCT02976376.

International registered report identifier (irrid): RR2-10.2196/resprot.8038.

Keywords: cost of care; cost-effectiveness; cost-utility; eHealth; myocardial infarction; outpatients; quality of life; remote monitoring; smart technology.

Conflict of interest statement

Conflicts of Interest: RT reports receiving personal fees from Boston Scientific, Pfizer, and Sanofi outside the submitted work. SB reports receiving personal fees from Boston Scientific outside the submitted work. All other authors report no conflicts of interest.

©Roderick Willem Treskes, M Elske van den Akker-van Marle, Louise van Winden, Nicole van Keulen, Enno Tjeerd van der Velde, Saskia Beeres, Douwe Atsma, Martin Jan Schalij. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.04.2022.

Figures

Figure 1
Figure 1
Mean pooled utilities per randomization group at one, six and twelve months after study inclusion.
Figure 2
Figure 2
Scatter plot of incremental costs and incremental quality-adjusted life years in the base-case analysis. QALY: quality-adjusted life years.
Figure 3
Figure 3
Scatter plot of incremental costs and incremental quality-adjusted life years in the sensitivity analysis. QALY: quality-adjusted life years.
Figure 4
Figure 4
Cost-effectiveness acceptability curve. A currency exchange rate of €1=US $1.0994 is applicable. QALY: quality-adjusted life years.

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