The impact of remote monitoring of implanted cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy device (CRT-D) patients on healthcare costs in the Silesian population: three-year follow-up.
BACKGROUND
The population of patients with implanted cardioverter-defibrillators (ICD) and cardiac resynchronisation therapy devices (CRT-D) is constantly growing. The use of remote-monitoring (RM) techniques in this group can significantly improve clinical outcomes, but there are limited data about the impact of RM on healthcare costs from a payer's perspective.


OBJECTIVE
The aim of the study was to assess the impact on costs for the healthcare system of RM in patients with ICD or CRT-D.


METHODS
We examined a cohort of 842 patients with ICD or CRT-D. The group was divided into two groups based on RM (or no RM [NRM]), matched according to important clinical characteristics. The subjects were followed for a maximum of three years after implantation (mean follow-up 2.11 ± 0.83 years). The overall costs for the healthcare provider in the follow-up were defined as the primary endpoint. The secondary endpoint was the use of different types of medical contact events: hospitalisation and number of in-clinic and general practitioner visits (without the number of remote transmissions).


RESULTS
In the three-year follow-up, the reduction in the costs of treatment for National Health Care in the RM group was 33.5% (median value, p < 0.001). In patients with implanted CRT-D, the reduction reached 42.7% (p = 0.011), and with ICD it was 31.3% (p = 0.007). We observed no significant reduction in the median hospitalisation costs in the three-year follow-up in the RM group (p = NS), despite a 25% drop in the mean value. The costs of outpatient visits were slightly higher in the RM group (p = NS). In the follow-up period, there was no reduction in the number of medical contact events (p = NS).


CONCLUSIONS
Remote monitoring in patients with implanted ICD or CRT-D devices reduces the cost for the national healthcare provider.
Third Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland, Poland. piotr.buchta@gmail.com.
Piotr
P
Buchta
Mateusz
M
Tajstra
Anna
A
Kurek
Michał
M
Skrzypek
Małgorzata
M
Świetlińska
Elżbieta
E
Gadula-Gacek
Michał
M
Wasiak
Łukasz
Ł
Pyka
Mariusz
M
Gąsior
D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000191:economics*; D011044:Poland
cardioverter-defibrillator; healthcare costs; heart failure; remote monitoring