Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial.
Alert-driven vs scheduled remote monitoring of implantable cardiac defibrillators: A cost-consequence analysis from the TRUST trial.
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植入式心脏除颤器的警报驱动与预定远程监测：TRUST 试验的成本后果分析。
DOI：
10.1016/j.hrthm.2022.12.003
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发表时间：
2023
期刊：
影响因子：
5.5
通讯作者：
TRUSTInvestigators
中科院分区：
文献类型：
--
作者：
Chew,DerekS;Piccini,JonathanP;Au,Flora;Frazier-Mills,CamilleG;Michalski,Justin;Varma,Niraj;TRUSTInvestigators
背景 警报驱动的远程患者监测 (RPM) 或无需常规评估的完全虚拟护理可以减少诊所工作量并促进更有效的资源分配，主要是通过减少不可操作的患者接触。目的 本研究的目的是进行成本-后果分析，以比较 3 种植入式心律转复除颤器 (ICD) 植入后随访策略：(1) 仅亲自评估 (IPE)；(2) RPM – 传统（IPE 和 RPM 的混合）； (3) RPM-警报（基于警报的 ICD 随访）。方法 我们构建了一个决策分析马尔可夫模型，从美国医疗保险付款人的角度来估计这 3 种策略在 2 年时间范围内的成本和收益。来自 TRUST（Lumos-T Safely RedUceS RouTine Office Device Follow-up）随机临床试验的汇总数据和患者级别数据为临床有效性模型输入提供了信息。 TRUST 将 1339 名患者以 2:1 的比例随机分配至传统 RPM 或单独 IPE，发现 RPM 是安全的，并且减少了无法采取行动的情况的数量。成本数据来自已发表的文献。主要结果是增量成本。结果 IPE 组每位患者的平均累积随访费用为 12,688 美元，RPM 常规组为 12,001 美元，RPM 警报组为 11,011 美元。与 IPE 组相比，RPM 传统组和 RPM 警报组的增量成本分别较低，分别为 – 687 美元（95% 置信区间 [CI] – 2138 美元至+ 638 美元）和 – 1,677 美元（95% CI – 3134 美元至 – 304 美元）。因此，RPM 警报策略最具成本效益，预计可在 99% 的模拟中节省成本。结论 警报驱动的 RPM 在经济上具有吸引力，如果患者的结果和安全性与传统 RPM 相当，则可能是 ICD 随访的首选策略。
Background Alert-driven remote patient monitoring (RPM) or fully virtual care without routine evaluations may reduce clinic workload and promote more efficient resource allocation, principally by diminishing nonactionable patient encounters. Objective The purpose of this study was to conduct a cost–consequence analysis to compare 3 postimplant implantable cardioverter-defibrillator (ICD) follow-up strategies:(1) in-person evaluation (IPE) only;(2) RPM–conventional (hybrid of IPE and RPM); and (3) RPM–alert (alert-based ICD follow-up). Methods We constructed a decision-analytic Markov model to estimate the costs and benefits of the 3 strategies over a 2-year time horizon from the perspective of the US Medicare payer. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) randomized clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2: 1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of nonactionable encounters. Cost data were obtained from the published literature. The primary outcome was incremental cost. Results Mean cumulative follow-up costs per patient were $12,688 in the IPE group, $12,001 in the RPM–conventional group, and $11,011 in the RPM–alert group. Compared to the IPE group, both the RPM–conventional and RPM–alert groups were associated with lower incremental costs of–$687 (95% confidence interval [CI]–$2138 to+ $638) and–$1,677 (95% CI–$3134 to–$304), respectively. Therefore, the RPM–alert strategy was most cost-effective, with an estimated cost-savings in 99% of simulations. Conclusions Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to those of conventional RPM, may be the preferred strategy for ICD follow-up.
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影响因子：
6.2
作者：
Chew, Derek S.;Zarrabi, Mahmood;Wilton, Stephen B.
通讯作者：
Wilton, Stephen B.
DOI：
10.1016/j.jacep.2017.02.007
发表时间：
2017-04-01
期刊：
JACC. Clinical electrophysiology
影响因子：
--
作者：
Ploux, Sylvain;Varma, Niraj;Bordachar, Pierre
通讯作者：
Bordachar, Pierre
影响因子：
6.1
作者：
Varma, Niraj;Love, Charles J.;Epstein, Andrew E.
通讯作者：
Epstein, Andrew E.
影响因子：
24
作者：
Varma, Niraj;Piccini, Jonathan P.;Mittal, Suneet
通讯作者：
Mittal, Suneet
DOI：
10.7326/l17-0044
发表时间：
2017-04
期刊：
Annals of Internal Medicine.
影响因子：
--
作者：
Alexander Sandhu;Daniel Ollendorf;Richard Chapman;Steven Pearson;Paul Heidenreich
通讯作者：
Alexander Sandhu;Daniel Ollendorf;Richard Chapman;Steven Pearson;Paul Heidenreich