Cost-Effectiveness of Telemedicine and Ambulatory Care for Chronic Wound Management in Norway: A Decision Analytic Model

OBJECTIVES: This study aims to estimate the cost-effectiveness of telemedicine (TM) and ambulatory care (TELE-AMBUS) compared to the standard of care (SoC) for treatment of patients with chronic wounds.

METHODS: A model-based cost-effectiveness analysis was conducted. A Markov model was constructed to simulate a progression of chronic wounds for patients receiving ICT-based TM and ambulatory care compared to SoC. Model parameters were extracted from national register database, clinical intervention, as well as from published literature. Costs are viewed from the perspective of health care payers. The primary effectiveness outcome was changes in quality-adjusted life year (QALY) from a decision to implement TELE-AMBUS compared with SoC. A microsimulation state-transition model was used with a cycle length of 1 month and a time horizon of 12 months. We also considered a time horizon of 5 years to incorporate the long-term recurrence of chronic wounds. Both deterministic and probabilistic sensitivity analyses were undertaken to test the robustness of model results.

RESULTS: The TELE-AMBUS treatment was generally more costly and more effective than the SoC. Under the base-case assumptions, where the benefits of the intervention are sustained over 12 months, patients treated with ICT-based TM and ambulatory care experienced better health (0.63 QALYs per patient) compared to those receiving SoC. The incremental costs were $922, yielding incremental cost-effectiveness ratio (ICER) of $1 462. This incremental cost per QALY gained is considered highly cost-effective in a Norwegian setting. Robustness of results are ascertained in scenario and sensitivity analyses.

CONCLUSIONS: The findings of this study suggest that TELE-AMBUS is cost-effective compared to SoC in the management of patients with chronic wounds. Investment in ICT-based TM and ambulatory care targeting the elderly and other vulnerable groups could be affordable and have a positive impact on health improvement.