OBJECTIVES : To estimate from the payer perspective, the cost and clinical consequences of a Remote Patient Monitoring (RPM) program, supported in Sharesource® technology, to improve the clinical practice in automated peritoneal dialysis (APD) from different US payer perspectives.

METHODS : A one year Markov analytic model, structured in five health states, was used to project costs and clinical outcomes from a hypothetical cohort of 100 APD patients with and without RPM. Hospitalization rates, length of stay and complication rates were estimated from literature and the United States Renal Data System (USRDS). Base case associated health state costs were estimated from literature and 2006 AHRQ report (1). Model results were reported as net costs, months free of complications, avoided hospitalizations, reduction in hospitalization days and avoided peritonitis episodes. Both deterministic and probabilistic sensitivity analyses were done to analyze the effect of parameter uncertainty and cost variability in the model results. Secondary análisis will be done to capture different sub-systems costs and emerging information.

RESULTS : The implementation of a RPM program in a hypothetical cohort of 100 APD patients during one year resulted in: net savings of USD -$ 5,572,103 (USD -$ 55,721 per patient per year); 48 months free of complications; 45 hospitalization episodes avoided; reduction in 1,098 hospitalization days and 7 peritonitis episodes avoided. Cost saving results were maintained in all the scenarios of the deterministic sensitivity analysis, with the differences in hospitalization rate, hospitalization costs and length of stay being the most sensitive drivers of the model results. In the probabilistic sensitivity analysis, there was a 100% of chance of dominance.

CONCLUSIONS : APD with RPM supported by Sharesource® technology is a cost saving alternative, potentially improving patient time free of complication, hospitalization burden and peritonitis risk.

(1) Inpatient Hospital Stays for Principal Diagnosis: Average Length of Stay and Average Charges, 2006 Obtained from https://www.hcup-us.ahrq.gov/reports/factsandfigures/figures/2006/2006_4_3.jsp