HRS: Hospitals save using remote ICD monitoring strategy
BOSTON—Remote monitoring with implantable cardioverter-difibrillators (ICDs) was found to be cost-effective for hospitals, according to a session presented by Leonardo Calo, MD, of the cardiology division at Policlinico Casilino in Rome, May 10 at the 33rd annual scientific sessions of the Heart Rhythm Society. Remote monitoring also reduced patients' expenses.

“Few studies have evaluated the economic impact of remote cardiac ICD management,” he stated. Calo and colleagues set out to assess current direct costs of an ICD follow-up strategy based on remote monitoring compared with conventional in-hospital follow-up.

Two hundred and thirty-three patients with indications for ICD were consecutively recruited and randomized at implant to be followed for one year with standard quarterly in-hospital visits or by remote monitoring with only one in-hospital visit per year, unless required by specific patient conditions or remote monitoring alarms or notifications.

Costs were calculated distinguishing between those incurred by the hospital (costs of medical and nursing hospital staff for standard and remote monitoring follow-up for each single patient expressed as amount of Euros per minute representing the main cost account in the hospital budget for ICD follow-up) and social costs supported by patients (“ticket” costs, travel costs, cost of lost employment income for the time).

“Personnel cost mainly depends on the working time necessary to support follow-up. The resulting mean cost per working minute was EUR 0.51 (USD 0.66) and EUR 0.21 (USD 0.27) for medical and nursing personnel, respectively,” Calo said.

The majority of patients were retired (81 percent) and accompanied by a relative or a caregiver (72 percent) who asked for special permission at work (43 percent). Time spent by a patient for a single visit (home-to-hospital and back trip, waiting and visit time) was around two hours. The scheduled in-hospital visits were less frequent in the remote monitoring group than in the control arm, while unscheduled in-hospital visits were similar.  There were 520 follow-ups in the remote monitoring group and 489 in the control group.

The cost increase in the control arm was mostly due to a longer time for physicians involved in the follow-up (47 minutes per patient/year in the remote monitoring arm vs. 85 minutes in the control arm), generating cost estimates for the physicians of EUR24 (USD $31) and EUR44 (USD $57) per patient/year, respectively. Nurses’ costs were comparable. Overall, the costs associated with remote monitoring were EUR39.67 (USD $50).

Patients in the remote monitoring arm enjoyed mean cost savings of about EUR156 (USD $202) per year, according to the researchers. Calo concluded the remote monitoring strategy saved almost EUR25 (USD $32) per patient per year.