Remote Monitoring As a Digital Health Intervention in the Management of Heart Failure in the United Kingdom: A Cost-Effectiveness Analysis

OBJECTIVES: Patients with heart failure (HF) are at high risk of readmission, mortality, and morbidity after hospitalisation. Remote monitoring (RM), using digital information and communication techniques to monitor patients’ vital signs and other diagnostic data outside healthcare settings, can reduce these key risks. This study assessed the cost-effectiveness of RM for the management of patients with stable HF discharged from hospitals in the UK.

METHODS: A Markov cohort model was developed consisting of two health states: ‘Alive’ and ‘Death’. During each monthly cycle, patients within the Alive state are at risk of re-hospitalization (due to HF or other causes) and can transition to the Death state. Efficacy data were based on a published meta-analysis. The model used a lifetime horizon and took both payer and societal perspectives. RM costs (license, setup and implementation, measurement tool), medical care costs, hospitalisation costs and costs for care at home or institutions were considered. The model estimated cost, quality-adjusted life year (QALY) and the incremental cost-effectiveness ratio (ICER) of RM versus usual care (UC). Uncertainty was assessed using a one-way sensitivity analysis, scenario analysis and probabilistic sensitivity analysis (PSA).

RESULTS: From the payer perspective, RM incurred an incremental cost of £1,586 and incremental QALY of 0.13, resulting in an ICER of £12,588/QALY versus UC. One-way sensitivity analysis results identified relative risk of mortality and of hospitalisation as the key drivers. The PSA showed, at a willingness to pay (WTP) threshold of £20,000/QALY, RM has an 85.9% probability of being cost-effective compared to UC. Scenario analyses using societal perspective, 5-year intervention duration, different time horizons and discounting rates all reported ICERs below £20,000/QALY.

CONCLUSIONS: RM was found to be cost-effective at WTP threshold of £20,000/QALY compared to UC. Further research on the long-term impact of RM use on HF outcomes in the UK is required.