Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery

Abstract

Background: Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone.

Methods: A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty.

Results: The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone.

Conclusions: Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.

Trial registration: ClinicalTrials.gov NCT03760796.

Conflict of interest statement

Under a license agreement between Corrie Health and the Johns Hopkins University, the University owns equity in Corrie Health, and the University and Drs F.A.M., M.A.L., and S.S.M. are entitled to royalty distributions related to the technology described in the study discussed in this publication. In addition, Drs F.A.M., M.A.L., and S.S.M. are co-founders of and hold equity in Corrie Health. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. S.S.M. reports consulting in the last 36 months with Amgen, AstraZeneca, Esperion, iHealth, Kaneka, Novo Nordisk, Sanofi, Regeneron, REGENXBIO, and 89bio. He is a co-inventor on a system to estimate LDL cholesterol levels, patent application pending. W.V.P. reports consulting with Monument Analytics. The remaining authors declare no conflict of interest.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1.

Markov model for post-MI patients. Discharged patients can cycle through 3 states - no complications (stable outpatient), readmissions for recurrent AMI, or readmissions for another cause (e.g., pneumonia). Patient mortality is represented by the death state.

Figure 2.

An incremental cost-effectiveness ratio (x) scatterplot from the Bayesian Multivariate probabilistic sensitivity analysis regarding the use of Corrie compared to standard discharge practices alone, based on 10,000 Monte Carlo simulations.