EuroEco: Financial Impact of ICD Remote Monitoring in Six European Countries
The cost of remotely monitoring patients with implantable cardiac defibrillators (ICDs) to physicians, hospitals and insurance providers is the same as traditional in-office monitoring, according to results from the European Health Economic Trial on Home Monitoring in ICD Therapy (EuroEco) trial presented Sept. 1 at ESC Congress 2014 and simultaneously published in European Heart Journal. However, there is wide variation across Europe in the financial burden that physicians and hospitals face in switching to this approach, due to national differences in insurance reimbursement.
The study followed 303 patients (average age 62.4 years, 81 percent male) from 17 centers in five European countries following placement of a single- or dual-chamber ICD equipped with home monitoring technology. Patients were randomized to either "home monitoring on" or "home monitoring off" and were followed for two years and had three mandatory in-office follow-up visits. Patients in the home monitoring off group also had routine in-office visits scheduled throughout the study, while those in the home monitoring on group were under continuous, automatic remote monitoring.
Overall results found that the home monitoring on group had a significantly higher number of unscheduled office visits, compared to the home monitoring off group, but the total number of visits (scheduled and unscheduled) was still much lower for home monitoring on patients (3.79 vs. 5.53, p<0.001). In addition, the same amount of staff time was required for both groups during the study period (176 minutes for home monitoring on patients vs. 178 minutes for home monitoring off patients). Physicians were the only staff who needed less time for home monitoring on patients, although the absolute difference was small (64 vs. 73 minutes, p=0.028), according to study investigators.
In terms of costs, the overall total follow-up cost for providers was not different for home monitoring on vs. home monitoring off patients (mean €204 vs. €213, respectively), neither was their net profit (€408 vs. €400). However, when broken down by country, providers in Belgium, Spain and The Netherlands, home monitoring brought in less profit because of a lack of reimbursement, while in Germany and the UK where such reimbursement exists, home monitoring was associated with maintained or increased profit. For payers, the total cost per patient (including other physician visits, examinations and hospitalizations) was slightly lower for home monitoring on patients, mainly as a result of fewer hospitalizations and shorter length-of-stays. However, total payer costs did not increase in any country.
"Since our study shows that total insurance costs do not increase, and home monitoring actually reduces hospitalizations and length of stay as seen in prior trials, we hope our results will allow informed discussions between payers, providers and manufacturers to come to balanced reimbursement scenarios in order to stimulate reorganization towards remote monitoring-based care," said the study’s principal investigator Hein Heidbuchel, MD, PhD, from the Heart Center Hasselt, Belgium.
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