title: Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.
abstract: Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p <0.0001). In conclusion, remote monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care.
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York. Electronic address: jladapo@post.harvard.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ladapo
authors.affiliation: Stanford University/Cardiac Electrophysiology, VA Palo Alto Healthcare System, Palo Alto, California.
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.affiliation: Data Analytics, CTI Clinical Trial and Consulting Services, Inc., Cincinnati, Ohio.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Ryan
authors.affiliation: Global Healthcare Economics and Reimbursement, Medtronic plc, Mounds View, Minnesota.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Mollenkopf
authors.affiliation: Economics and Quality of Life Research, Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D010138:Pacemaker, Artificial; D057216:Propensity Score; D019114:Remote Consultation / Q000191:economics*; D058998:Remote Sensing Technology / Q000191:economics; D055815:Young Adult