OBJECTIVES

We propose a methodology framework for evaluating complex intervention programs on connected care platforms such as remote patient monitoring for populations with long-term conditions in their potential in ROI for health care organizations and in their cost effectiveness for pending market introduction by health systems or payers.

METHODS

We built a probabilistic decision-analytic model to compare patient-reported costs and outcomes on QALYs of remote patient monitoring in addition to usual care given the published evidence and uncertainty from the Whole Systems Demonstrator Study which was setup in the United Kingdom from 2008 to 2009 [1]. The model was populated with as-reported survivor-specific QALYs distribution and compared to adjusted QALYs to compensate the effect of different mortality rates among the control and intervention group. We computed metrics such as, net monetary benefit, incremental cost effectiveness ratio and acceptability, expected value of perfect information and ROI.

RESULTS

The WSD reported an ICER of £92,000 and an CEA of 11% at willingness to pay threshold of £30 000 [1]. Our unadjusted model produced an ICER of £52,300 with an CEA of 38%. The adjusted QALY model produced an ICER of £24,800. At this level, the probability of cost effectiveness increased to 56%.

CONCLUSIONS

Single-point measurements of QALY in an end-of-life population can cause bias which in turn can influence decision making on cost effectiveness of interventions. We suggest program effectiveness measurements to be taken repeatedly over time, covering the whole cohort at baseline and adjusting for non-survivors during follow-up, by collecting information on defined outcome measures from patients, clinicians, and administrative sources. The selected measures can be translated in the quadruple aim around lowered cost, improved staff experience, improved health outcomes and patient experience.

[1] Cost effectiveness of telehealth for patient with long term conditions (Whole Systems Demonstrator study). Henderson et al. BMJ 2013