title: Cost-utility analysis of the EVOLVO study on remote monitoring for heart failure patients with implantable defibrillators: randomized controlled trial.
abstract: BACKGROUND
  Heart failure patients with implantable defibrillators place a significant burden on health care systems. Remote monitoring allows assessment of device function and heart failure parameters, and may represent a safe, effective, and cost-saving method compared to conventional in-office follow-up.
  
  
  OBJECTIVE
  We hypothesized that remote device monitoring represents a cost-effective approach. This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators (EVOLVO) study, a multicenter clinical trial aimed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators.
  
  
  METHODS
  Two hundred patients implanted with a wireless transmission-enabled implantable defibrillator were randomized to receive either remote monitoring or the conventional method of in-person evaluations. Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups. The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient. A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality-adjusted life year (QALY) gained.
  
  
  RESULTS
  Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution.
  
  
  CONCLUSIONS
  Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00873899; http://clinicaltrials.gov/show/NCT00873899 (Archived by WebCite at http://www.webcitation.org/6H0BOA29f).
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway. paolo.zanaboni@telemed.no
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanaboni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marzegalli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Perego
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guenzati
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.forename: Francesca
authors.initials: F
authors.lastname: Borghetti
authors.forename: Gabriella
authors.initials: G
authors.lastname: Borghi
authors.forename: Cristina
authors.initials: C
authors.lastname: Masella
mesh_terms: D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008991:Monitoring, Physiologic / Q000191:economics / Q000379:methods*
keywords: cost-effectiveness; heart failure; implantable defibrillators; telemedicine