title: Economic cost of home-telemonitoring care for BiPAP-assisted ALS individuals.
abstract: Our objective was to measure direct (hospital and NHS) and indirect (patient/caregiver) costs of following up in-home compliance to non-invasive ventilation via wireless modem. We constructed a prospective controlled trial of 40 consecutive ALS home-ventilated patients, randomly assigned according to their residence area to G1 (nearby hospital, office-based follow-up) and G2 (outside hospital area, telemetry device-based follow-up). Total NHS direct cost encompassed costs related to outpatients' visits (office and emergency room) and hospitalizations. Hospital direct costs included transportation to/from hospital, office visit per hour cost and equipment maintenance. Non-medical costs considered days of wages lost due to absenteeism. G1 included 20 patients aged 60 ± 10 years and G2 included 19 patients aged 62 ± 13 years. Results showed that no differences were found regarding clinical/demographic characteristics at admission. NHS costs showed a 55% reduction in average total costs with a statistically significant decrease of 81% in annual costs per patient in G2. Hospital costs were found to be significantly higher in G2 with regard to total costs (64% average increase) but not annual costs (7%). No statistical difference was found with regard to expenses from absenteeism. In conclusion, at the cost of an initial financial constraint to the hospital per year (non-significant), telemonitoring is cost-effective, representing major cost savings to the NHS in the order of 700 euros/patient/year.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Santa Maria Hospital, Lisbon, Portugal. jpedro.gla@gmail.com
authors.forename: J Pedro
authors.initials: JP
authors.lastname: Lopes de Almeida
authors.forename: Anabela
authors.initials: A
authors.lastname: Pinto
authors.forename: Susana
authors.initials: S
authors.lastname: Pinto
authors.forename: Benjamim
authors.initials: B
authors.lastname: Ohana
authors.forename: Mamede
authors.initials: M
authors.lastname: de Carvalho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000191:economics* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult