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EuroEco (European Health Economic Trial on Home Monitoring in ICD Patients): A Provider Perspective in Five European Countries on Costs and Net Financial Impact of Follow-Up With or Without Remote Monitoring
Study Questions:
In the first 2 years following implantation of an implantable cardiac defibrillator (ICD), what is the total follow-up (FU)-related cost for providers for home monitoring facilitated FU (HM ON) compared to regular in-office FU (HM OFF)?
Methods:
This was a randomized, multicenter, nonblinded, parallel-design trial conducted in six European countries. Patients were enrolled prior to ICD implantation, after which they were randomized to receive HM OFF or HM ON for 2 years. All medical contacts were recorded and staff consumption was determined. The authors conducted a cost analysis in which provider net income was calculated as the difference between payer reimbursement for FU services and provider-related costs. Of note, remote FU equipment costs were not included in the cost analysis.
Results:
The analytic sample included 303 patients. Compared to the HM OFF group, the HM ON group had less follow-up visits (3.79 ± 1.67 vs. 5.53 ± 2.32; p < 0.001), but a small increase in unscheduled visits and more nonoffice-based contacts. There was a trend toward fewer cardiovascular rehospitalizations and shorter length of stay in the HM ON group. The net financial impact on providers was not significantly different with a profit of €408 (327-489) in the HM ON group, versus €400 (345-455) in the HM OFF group. There was heterogeneity among the participating countries, owing to less profit for providers in select countries without specific reimbursement for follow-up.
Conclusions:
Although there is heterogeneity among countries, FU-related costs for providers are not different for remote FU versus in-office FU for patients who have received an ICD.
Perspective:
Remote monitoring technology in ICD recipients has been available for the past decade and has been shown to be noninferior clinically. The EuroEco adds to this literature by showing that remote monitoring, compared to in-office FU, does not impact provider cost or income. As there was heterogeneity among participating countries, effective and broad implementation of remote monitoring will certainly necessitate a favorable, established infrastructure for reimbursement.
Keywords: Defibrillators, Implantable, Length of Stay
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