Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial

Anne Sig Vestergaard, Louise Hansen, Sabrina Storgaard Sørensen, Morten Berg Jensen, Lars Holger Ehlers, Anne Sig Vestergaard, Louise Hansen, Sabrina Storgaard Sørensen, Morten Berg Jensen, Lars Holger Ehlers

Abstract

Objective: This study aimed to assess the cost-effectiveness of telehealthcare in heart failure patients as add-on to usual care.

Design: A cost-utility analysis was conducted from a public payer perspective alongside the randomised controlled TeleCare North trial.

Setting: The North Denmark Region, Denmark.

Participants: The study included 274 heart failure patients with self-reported New York Heart Association class II-IV.

Interventions: Patients in the intervention group were provided with a Telekit consisting of a tablet, a digital blood pressure monitor, and a scale and were instructed to perform measurements one to two times a week. The responsibility of the education, instructions and monitoring of the heart failure (HF) patients was placed on municipality nurses trained in HF and telemonitoring. Both groups received usual care.

Outcome measures: Cost-effectiveness was reported as incremental net monetary benefit (NMB). A micro-costing approach was applied to evaluate the derived savings in the first year in the public health sector. Quality-adjusted life-years (QALY) gained were estimated using the EuroQol 5-Dimensions 5-Levels questionnaire at baseline and at a 1-year follow-up.

Results: Data for 274 patients were included in the main analysis. The telehealthcare solution provided a positive incremental NMB of £5164. The 1-year adjusted QALY difference between the telehealthcare solution and the usual care group was 0.0034 (95% CI: -0.0711 to 0.0780). The adjusted difference in costs was -£5096 (95% CI: -8736 to -1456) corresponding to a reduction in total healthcare costs by 35%. All sensitivity analyses showed the main results were robust.

Conclusions: The TeleCare North solution for monitoring HF was highly cost-effective. There were significant cost savings on hospitalisations, primary care contacts and total costs.

Trial registration number: ClinicalTrials.gov: NCT02860013.

Keywords: health economics; health informatics; heart failure; telemedicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flowchart of exclusion of patients for the economic evaluation.
Figure 2
Figure 2
Incremental cost-effectiveness scatter plot based on the probabilistic sensitivity analysis. The dotted line indicates a cost-effectiveness threshold of £20 000 per quality-adjusted life-year (QALY).

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