title: Cost-consequence analysis of daily continuous remote monitoring of implantable cardiac defibrillator and resynchronization devices in the UK.
abstract: OBJECTIVE
  The need for ongoing and lifelong follow-up (FU) of patients with cardiac implantable electric devices (CIED) requires significant resources. Remote CIED management has been established as a safe alternative to conventional periodical in-office FU (CFU). An economic model compares the long-term cost and consequences of using daily Home Monitoring® (HM) instead of CFU.
  
  
  RESULTS
  A cost-consequence evaluation comparing HM vs. CFU was performed using a Markov cohort model and data relating to events and costs identified via a systematic review of the literature. The model is conservative, without assuming a reduction of cardiovascular events by HM such as decompensated heart failure or mortality, or considering cost savings such as for transportation. Also cost savings due to an improved timing of elective device replacement, and fewer FU visits needed in patients near device replacement are not considered. Over 10 years, HM is predicted to be cost neutral at about GBP 11 500 per patient in either treatment arm, with all costs for the initial investment into HM and fees for ongoing remote monitoring included. Fewer inappropriate shocks (-51%) reduce the need for replacing devices for battery exhaustion (-7%); the number of FU visits is predicted to be halved by HM.
  
  
  CONCLUSIONS
  From a UK National Health Service perspective, HM is cost neutral over 10 years. This is mainly accomplished by reducing the number of battery charges and inappropriate shocks, resulting in fewer device replacements, and by reducing the number of in-clinic FU visits.
authors.affiliation: Electrophysiology Unit, University Hospital of Geneva, Rue Perret-Gentil 4, CH-1211, Geneva 14, Switzerland.
authors.forename: Haran
authors.initials: H
authors.lastname: Burri
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.forename: Koji
authors.initials: K
authors.lastname: Makino
authors.forename: Antje
authors.initials: A
authors.lastname: Smala
authors.forename: Dominic
authors.initials: D
authors.lastname: Tilden
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics*; D003365:Costs and Cost Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D018670:Monitoring, Ambulatory / Q000191:economics* / Q000295:instrumentation; D008991:Monitoring, Physiologic / Q000191:economics* / Q000295:instrumentation; D009819:Office Visits / Q000191:economics; D013222:State Medicine; D017216:Telemedicine / Q000191:economics* / Q000295:instrumentation; D006113:United Kingdom / Q000453:epidemiology
keywords: Cardiac resynchronization therapy; Cost-effectiveness analysis; Health-care costs; Implantable defibrillator; Markov chain; Remote monitoring