Cost-utility analysis of telemonitoring versus conventional hospital-based follow-up of patients with pacemakers. The NORDLAND randomized clinical trial
Cost-utility analysis of telemonitoring versus conventional hospital-based follow-up of patients with pacemakers. The NORDLAND randomized clinical trial
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DOI：
10.1371/journal.pone.0226188
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发表时间：
2020-01-29
期刊：
影响因子：
3.7
通讯作者：
Lopez-Liria, Remedios
中科院分区：
文献类型：
--
作者：
Lopez-Villegas, Antonio;Catalan-Matamoros, Daniel;Lopez-Liria, Remedios
本研究的目的是进行一项经济评估，以检查使用起搏器进行远程监测是否比在门诊诊所进行传统随访更具成本效益。方法采用NORDLAND试验的疗效和成本数据，该试验是一项对照、随机、非蒙面临床试验。50例患者接受远程监护（TM, n = 25）或常规监护（CM, n = 25），并在植入后随访12个月。从挪威国家医疗保健系统和患者及其护理人员的角度，根据每增加质量调整生命年（QALY）的额外成本进行成本效用分析。结果两种替代方案的有效性相似（TM: 0.7804 [CI: 0.6864至0.8745]vs. CM: 0.7465 [CI: 0.6543至0.8387]），而RM组的每位患者成本更高，从挪威NHS的角度来看(TM: (sic)2,079.84 [CI: 0.00至4,610.58]vs. (sic)271.97 [CI: 158.18至385.76]；p = 0.147)，包括患者/家庭视角(TM: (sic)2,295.91 [CI: 0.00至4,843.28]vs. CM: (sic) 430.39 [CI: 0.00至4,841.48])，尽管这些巨大的差异（主要是由于TM组住院患者很少，而CM组没有住院患者）没有达到统计学意义。增量成本效益比（ICER）从挪威NHS的角度来看（sic） 53,345.27/QALY)，包括患者/护理者的角度（sic）55,046.40/QALY)，以及增量净收益（INB），支持CM替代方案，尽管95%的ci非常广泛。由于广泛的ci，概率分析证实了不确定的结果，甚至表明TM在本研究中不具有成本效益。排除住院费用的补充分析显示，inb为正，这表明如果不考虑住院费用，RM替代方案具有离散的优势，尽管ci也很广泛。结论：TM与CM的成本-效用分析显示不确定的结果，因为ICER和INB数据的置信区间很宽，从潜在的节省到额外QALY的高成本，大多数ICERs高于通常的NHS覆盖决策阈值。
IntroductionThe aim of our study was to perform an economic assessment in order to check whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics.MethodsWe used effectiveness and cost data from the NORDLAND trial, which is a controlled, randomized, non-masked clinical trial. Fifty patients were assigned to receive either telemonitoring (TM; n = 25) or conventional monitoring (CM; n = 25) and were followed up for 12 months after the implantation. A cost-utility analysis was performed in terms of additional costs per additional Quality-Adjusted Life Year (QALY) attained from the perspectives of the Norwegian National Healthcare System and patients and their caregivers.ResultsEffectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: (sic)2,079.84 [CI: 0.00 to 4,610.58] vs. (sic)271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: (sic)2,295.91 [CI: 0.00 to 4,843.28] vs. CM: (sic) 430.39 [CI: 0.00 to 4,841.48]), although these large differences-mainly due to a few patients being hospitalized in the TM group, as opposed to none in the CM group-did not reach statistical significance. The Incremental Cost-Effectiveness Ratio (ICER) from the Norwegian NHS perspective (sic) 53,345.27/QALY) and including the patient/caregiver perspective (sic)55,046.40/QALY), as well as the Incremental Net Benefit (INB), favors the CM alternative, albeit with very broad 95%CIs. The probabilistic analysis confirmed inconclusive results due to the wide CIs even suggesting that TM was not cost-effective in this study. Supplemental analysis excluding the hospitalization costs shows positive INBs, whereby suggesting a discrete superiority of the RM alternative if hospitalization costs were not considered, albeit also with broad CIs.ConclusionsCost-utility analysis of TM vs. CM shows inconclusive results because of broad confidence intervals with ICER and INB figures ranging from potential savings to high costs for an additional QALY, with the majority of ICERs being above the usual NHS thresholds for coverage decisions.