The economic impact of ventilator dependent individuals tele-monitoring
| Author [ref.] | |||
| Lopes [6] | Vitacca [69] | Vitacca [23] | |
| Study design | NIV follow-up by tele-monitoring plus regular office visits at 3-month intervals versus NIV follow-up by regular office visits at hospital centre | Comparison of home on-demand mechanical cough assistance versus institutionalisation and versus continuous access to mechanical in-exsufflation in ALS patients | Tele-assistance programme versus usual out-patient follow up in patients with LTOT or HMV |
| Economic evaluation | Economic impact of home tele-monitoring | Cost-effectiveness | Cost-effectiveness |
| Study population | 2003–2006 prospective quasi-randomised and single-blind trial with ALS patients aged 18–75 years, 40 patients (20 tele-monitoring and 20 controls) | 2006–2008 39 ALS patients underwent follow-up: NIV n=15, tracheostomy MV n=12, and no ventilation n=12 | Prospective randomised clinical trial in 240 CRF patients |
| Outcome measurements | Intention-to-treat analysis considering three different type of costs, costs estimated by DRG | Mortality, call numbers, respiratory therapist visits, mechanical in-exsufflation requirement, avoided hospitalisations | Hospitalisations, home exacerbations, ER admissions, urgent GP calls, cost-
effectiveness Costs estimated by Medicare DRG |
| Type of costs | Hospital direct costs: outpatients' office and emergency visits, hospital admissions, transportation, price per hour consultant specialist, daily rental of ventilators and associated settings, daily maintenance of monitoring equipment; NHS directs costs: total costs for daily care for patient Indirect costs: non-medical costs considering loss of earnings due to caregivers absenteeism | On-call telephone access costs; respiratory therapist home visits; suction machine rental costs | Tele-medicine costs: call centre, nurse and medical second opinions, pulse oximetry device Healthcare system costs: hospitalisations in respiratory ward and in ICUs, ER admissions, outpatient visits, urgent GP visits, drugs and transportations |
| Results | Hospital costs mean total costs per patient higher in the intervention group €15 791±14 361 versus €5734±4276 (p=0.008), mean annual costs per patient not statistical different (control €8882.8±2718.5 intervention group €9508±1325) NHS direct costs. Both mean total costs per patient (p=0.058) and mean total annual costs per patient (p=0.005) higher in control group €19 665±5256 versus €8907±6553 for the first, and €44 134±11 316 versus €8186±6553 for the latter Indirect costs, differences in loss of earnings not significant | On-demand in-exsufflator comparison with continuous use of ventilator resulted in €108 758 cost savings, plus 34 hospitalisations avoided | Reduction of hospitalisations, higher probability of remaining free of acute exacerbations, higher probability of avoiding GP urgent calls after the first, and higher probability to avoid further ER admissions in tele-assistance group compared with control group Healthcare costs: deducting telemedicine cost, for tele-assistance patient group the mean overall costs per patient was €8907±17 580 and €14 728±28 694 for control group |
| Conclusions | Tele-monitoring of NIV in ALS cost-effective, € 700 per patient per year estimated long-term annual NHS cost saving | Telephone access and as needed HMV including manual assisted coughing cost effective | Au in severe and frail CRF patients on LTOT and or HMV, a nurse-centred tele-assistance programme is effective and cost-effective |
NIV: noninvasive ventilation; ALS: amyotrophic lateral sclerosis; LTOT: long-term oxygen therapy; HMV: home mechanical ventilation; MV: mechanical ventilation; CRF: chronic respiratory failure; DRG: diagnosis related group; ER: emergency room; GP: general practitioner; NHS: National Health Service; ICU: intensive care unit.