OBJECTIVES: Accelerated by the discussion of value frameworks, the “societal perspective” continues to gain traction in health technology assessment (HTA) agencies. There is debate about which costs outside the healthcare sector to include, especially about “future costs of non-medical consumption”. This study aims to assess the impact of adding the costs of informal care and costs of future (non)-medical consumption to the costs of healthcare and long-term care on the cost-effectiveness of remote patient management (RPM) for heart failure.

METHODS: We developed a Markov model with a lifetime horizon to assess the cost-effectiveness of non-invasive RPM compared with usual care (UC) from a societal and healthcare perspective in the Netherlands, the UK, and Germany. We included intervention costs, heart failure-related hospitalization and non-hospitalization costs, other medical costs unrelated to heart failure, informal care costs, and costs of non-medical consumption.

RESULTS: RPM increased life expectancy by 0.2 years. It reduced heart failure-related hospitalization costs, but total lifetime costs were higher than UC, in all three countries. From a healthcare perspective, the incremental cost-effectiveness ratios (ICERs) were €20,399, €17,479, and €19,294 in the Netherlands, the UK, and Germany, respectively. Expanding this perspective to include informal care costs, the ICERs increased to €22,490, €21,329, and €21,450 in the Netherlands, the UK, and Germany, respectively. Further expanding to a full societal perspective that includes non-medical consumption costs increased the ICERs to €35,970, €39,131, and €43,825 in the Netherlands, the UK, and Germany, respectively. Besides the costs of non-medical consumption, the ICER was sensitive to the effectiveness of RPM and utility values.

CONCLUSIONS: RPM is less cost-effective from a societal perspective than a healthcare perspective because of the costs of non-medical consumption in life years gained. However, given commonly used thresholds, RPM might still be considered cost-effective.