title: Results of a randomized controlled trial analyzing telemedically supported case management in the first year after living donor kidney transplantation - a budget impact analysis from the healthcare perspective.
abstract: ᅟ: We analyze one-year costs and savings of a telemedically supported case management program after kidney transplantation from the perspective of the German Healthcare System. Recipients of living donor kidney transplantation (N = 46) were randomly allocated to either (1) standard aftercare or (2) standard aftercare plus additional telemedically supported case management. A range of cost figures of each patient's medical service utilization were calculated at month 3, 6 and 12 and analyzed using two-part regression models. In comparison to standard aftercare, patients receiving telemedically supported case management are associated with substantial lower costs related to unscheduled hospitalizations (mean difference: €3,417.46 per patient for the entire one-year period, p = 0.003). Taking all cost figures into account, patients receiving standard aftercare are associated, on average, with one-year medical service utilization costs of €10,449.28, while patients receiving telemedically supported case management are associated with €5,504.21 of costs (mean difference: € 4,945.07 per patient, p < 0.001). With estimated expenditures of €3,001.5 for telemedically supported case management of a single patient, we determined a mean difference of €1,943.57, but this result is not statistically significant (p = 0.128). Sensitivity analyses show that the program becomes cost-neutral at around ten participating patients, and was beneficial starting at 15 patients. Routine implementation of telemedically supported case management in German medium and high-volume transplant centers would result in annual cost savings of €791,033 for the German healthcare system. Patients with telemedically supported case management showed a lower utilization of medical services as well as better medical outcomes. Therefore, such programs should be implemented in medium and high-volume transplant centers.
  
  
  BACKGROUND
  DRKS00007634 ( http://www.drks.de/DRKS00007634 ).
authors.affiliation: Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str 26, 79104, Freiburg, Germany. Kaier@imbi.uni-freiburg.de.
authors.forename: Klaus
authors.identifier: http://orcid.org/0000-0003-0837-6945
authors.initials: K
authors.lastname: Kaier
authors.affiliation: Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106, Freiburg, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Hils
authors.affiliation: Faculty of Economics, Aalen University, Beethovenstraße 1, 73430, Aalen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fetzer
authors.affiliation: Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str 26, 79104, Freiburg, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Hehn
authors.affiliation: Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106, Freiburg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schmid
authors.affiliation: Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str 26, 79104, Freiburg, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Hauschke
authors.affiliation: Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str 26, 79104, Freiburg, Germany.
authors.forename: Lioudmila
authors.initials: L
authors.lastname: Bogatyreva
authors.affiliation: Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106, Freiburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Jänigen
authors.affiliation: Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106, Freiburg, Germany.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
keywords: Cost-benefit; Cost-of-illness; Telemedicine