title: Cost-Utility Analysis of Telemonitoring Interventions for Patients with Chronic Obstructive Pulmonary Disease (COPD) in Germany.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) poses major challenges for health care systems. Previous studies suggest that telemonitoring could be effective in preventing hospitalisations and hence reduce costs.
  
  
  OBJECTIVE
  The aim was to evaluate whether telemonitoring interventions for COPD are cost-effective from the perspective of German statutory sickness funds.
  
  
  METHODS
  A cost-utility analysis was conducted using a combination of a Markov model and a decision tree. Telemonitoring as add-on to standard treatment was compared with standard treatment alone. The model consisted of four transition stages to account for COPD severity, and a terminal stage for death. Within each cycle, the frequency of exacerbations as well as outcomes for 2015 costs and quality adjusted life years (QALYs) for each stage were calculated. Values for input parameters were taken from the literature. Deterministic and probabilistic sensitivity analyses were conducted.
  
  
  RESULTS
  In the base case, telemonitoring led to an increase in incremental costs (€866 per patient) but also in incremental QALYs (0.05 per patient). The incremental cost-effectiveness ratio (ICER) was thus €17,410 per QALY gained. A deterministic sensitivity analysis showed that hospitalisation rate and costs for telemonitoring equipment greatly affected results. The probabilistic ICER averaged €34,432 per QALY (95 % confidence interval 12,161-56,703).
  
  
  CONCLUSIONS
  We provide evidence that telemonitoring may be cost-effective in Germany from a payer's point of view. This holds even after deterministic and probabilistic sensitivity analyses.
authors.affiliation: Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany. florian.hofer@uni-hamburg.de.
authors.forename: Florian
authors.identifier: http://orcid.org/0000-0003-2532-0919
authors.initials: F
authors.lastname: Hofer
authors.affiliation: Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany.
authors.forename: Dmitrij
authors.initials: D
authors.lastname: Achelrod
authors.affiliation: Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354, Hamburg, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Stargardt
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D018450:Disease Progression; D005858:Germany; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D018670:Monitoring, Ambulatory / Q000191:economics* / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000191:economics* / Q000628:therapy; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D017216:Telemedicine / Q000191:economics* / Q000379:methods