Telehealth Solution Highly Cost-Efficient for Heart Failure Patients

Anne Sig Vestergaard, PhD

A telehealth solution for monitoring heart failure was highly cost-effective.

Anne Sig Vestergaard, PhD, and colleagues studied 274 heart failure patients to assess the cost-effectiveness of telehealth as an add-on to standard care. The investigators found that there was a positive incremental net monetary benefit of nearly $6800.

Vestergaard, from the business and management department at Aalborg University in Denmark, and the team conducted a primary analysis with 134 patients in the intervention group and 140 in the control group from January 2016-March 2018. Eligible participants had a diagnosis of heart failure [7], a New York Heart Association classification of II-IV, and were expected to benefit from telehealth.

Patients in the telehealth group were monitored by educated municipality nurses. Patients were contacted by phone from a nurse and an appointment was made to discuss whether the patient wanted to receive a Telekit—a tablet, a digital blood pressure monitor, and a scale—in their home or at a municipality health center. Patients were instructed to perform measurements once or twice a week and the Telekit automatically reminded patients to do so. The nurses were trained in heart failure and telemonitoring and were responsible to educate and monitor the patients.

If a patient who was monitored had physical measurements outside of predefined thresholds (systolic blood pressure 100-170 mmHg; diastolic blood pressure 90-50 mmHg; pulse 80-55 beats per minute; and weight + 2 kg compared to baseline), the nurse had the option to:

• Contact the patient to ensure the accuracy of the measurement or have the measurement replicated
• Contact the patient to assess their condition
• Start a self-treatment plan for the patient
• Ask the patient to contact their own general practitioner if suitable
• Establish a rapport with the patient’s general practitioner directly

Those in the control group received standard care. Participants were offered rehabilitation of screening for risk factors and dietary advice, among other lifestyle changes. Rehabilitation generally lasted 3-6 months and was managed by general practitioners or outpatient clinics.

Within the one-year follow-up period, the group who used Telekit had a consistently lower resource consumption across all healthcare cost categories—hospitalizations, outpatient contacts, municipality costs, etc.—than the group that received usual care. The total raw difference was $7426 for an overall reduction of total healthcare costs by 35% with the use of the telemedicine platform. The lower mean cost per patient was driven by lower costs associated with hospitalizations (intervention group, $6623 vs control group, $11,876; P = .01).

The adjusted cost difference was $6675 (95% CI, −8736 to −1456), which indicated a significantly lower total mean cost per patient in the telehealth group than the control group. Telekit also provided a significant cost saving of $7255 (95% CI, −9483 to −1595). The telemedicine tool was proven to be cost-effective (net monetary benefit, $7243).

There was an insignificant gain in health-related quality of life among the telehealth participants (difference .0034; 95% CI, -.0711 to .078).

Although Telekit was found to be highly cost-effective, questions remain as to why, the investigators wrote. Future studies should seek to improve the understanding of why some interventions may prove effective and cost-effective, while others do not. The findings of those trials could increase the cost-effectiveness of future telehealth solutions.

The study, “Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial,” was published online in BMJ Open.