title: Economic impact of remote patient monitoring: an integrated economic model derived from a meta-analysis of randomized controlled trials in heart failure.
abstract: OBJECTIVE
  To assess the cost-effectiveness and the cost utility of remote patient monitoring (RPM) when compared with the usual care approach based upon differences in the number of hospitalizations, estimated from a meta-analysis of randomized clinical trials (RCTs).
  
  
  RESULTS
  We reviewed the literature published between January 2000 and September 2009 on multidisciplinary heart failure (HF) management, either by usual care or RPM to retrieve the number of hospitalizations and length of stay (LOS) for HF and for any cause. We performed a meta-analysis of 21 RCTs (5715 patients). Remote patient monitoring was associated with a significantly lower number of hospitalizations for HF [incidence rate ratio (IRR): 0.77, 95% CI 0.65-0.91, P < 0.001] and for any cause (IRR: 0.87, 95% CI: 0.79-0.96, P = 0.003), while LOS was not different. Direct costs for hospitalization for HF were approximated by diagnosis-related group (DRG) tariffs in Europe and North America and were used to populate an economic model. The difference in costs between RPM and usual care ranged from €300 to €1000, favouring RPM. These cost savings combined with a quality-adjusted life years (QALYs) gain of 0.06 suggest that RPM is a 'dominant' technology over existing standard care. In a budget impact analysis, the adoption of an RPM strategy entailed a progressive and linear increase in costs saved.
  
  
  CONCLUSIONS
  The novel cost-effectiveness data coupled with the demonstrated clinical efficacy of RPM should encourage its acceptance amongst clinicians and its consideration by third-party payers. At the same time, the scientific community should acknowledge the lack of prospectively and uniformly collected economic data and should request that future studies incorporate economic analyses.
authors.affiliation: Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gabutti
authors.forename: Arturo
authors.initials: A
authors.lastname: Raisaro
authors.forename: Moreno
authors.initials: M
authors.lastname: Curti
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D008991:Monitoring, Physiologic / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine / Q000191:economics*; D016896:Treatment Outcome