title: Economic impact of remote monitoring on ordinary follow-up of implantable cardioverter defibrillators as compared with conventional in-hospital visits. A single-center prospective and randomized study.
abstract: BACKGROUND
  Few data are available on actual follow-up costs of remote monitoring (RM) of implantable defibrillators (ICD). Our study aimed at assessing current direct costs of 1-year ICD follow-up based on RM compared with conventional quarterly in-hospital follow-ups.
  
  
  RESULTS
  Patients (N = 233) with indications for ICD were consecutively recruited and randomized at implant to be followed up for 1 year with standard quarterly in-hospital visits or by RM with one in-hospital visit at 12 months, unless additional in-hospital visits were required due to specific patient conditions or RM alarms. Costs were calculated distinguishing between provider and patient costs, excluding RM device and service cost. The frequency of scheduled in-hospital visits was lower in the RM group than in the control arm. Follow-up required 47 min per patient/year in the RM arm versus 86 min in the control arm (p = 0.03) for involved physicians, generating cost estimates for the provider of USD 45 and USD 83 per patient/year, respectively. Costs for nurses were comparable. Overall, the costs associated with RM and standard follow-up were USD 103 ± 27 and 154 ± 21 per patient/year, respectively (p = 0.01). RM was cost-saving for the patients: USD 97 ± 121 per patient/year in the RM group versus 287 ± 160 per patient/year (p = 0.0001).
  
  
  CONCLUSIONS
  The time spent by the hospital staff was significantly reduced in the RM group. If the costs for the device and service are not charged to patients or the provider, patients could save about USD 190 per patient/year while the hospital could save USD 51 per patient/year.
authors.affiliation: Division of Cardiology, Policlinico Casilino, ASL Roma B, Via Casilina, 1049, 00169, Rome, Italy. leonardo.calo@tin.it
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calò
authors.forename: Alessio
authors.initials: A
authors.lastname: Gargaro
authors.forename: Ermenegildo
authors.initials: E
authors.lastname: De Ruvo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Palozzi
authors.forename: Luigi
authors.initials: L
authors.lastname: Sciarra
authors.forename: Marco
authors.initials: M
authors.lastname: Rebecchi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Guarracini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fagagnini
authors.forename: Enrico
authors.initials: E
authors.lastname: Piroli
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lioy
authors.forename: Antonio
authors.initials: A
authors.lastname: Chirico
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000379:methods; D017147:Defibrillators, Implantable / Q000191:economics*; D019544:Equipment Failure Analysis / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017216:Telemedicine / Q000191:economics*