OBJECTIVES: This study explored two approaches of including the carbon footprint of an intervention into the HTA of remote patient management (RPM) compared to usual care (UC).

METHODS: In a 3-month quasi-experimental study, a cohort of patients starting RPM on the day of discharge from hospital after cardiac surgery was compared to a historical cohort of patients receiving usual care. In the RPM group, patients received home-monitoring devices and 50% of the planned outpatient visits was substituted by e-consultations. CO2-equivalents (CO2e) of both pathways were estimated using an adapted lifecycle analysis including the CO2e of the RPM-devices, RPM-data storage, e-consultations, physician visits, (re)admissions, and travel. In one approach, CO2e were converted into costs that were added to the total costs in a cost-utility analysis (CUA). In the other approach, CO2e were included as a decision criterion in multi-criteria decision analysis (MCDA).

RESULTS: Each cohort included 365 patients and characteristics were balanced. RPM reduced emergency department visits and (re)admissions but increased the percentage of patients with atrial fibrillation. There was no difference in EQ-5D-5L utility. The carbon footprint of RPM was 86 kg CO2e compared to 84 kg CO2e for UC. The reduction in (unplanned) hospital visits, admissions and travel in the RPM group reduced CO2e (-42), but this was offset by an increase in CO2e associated with the monitoring devices and data-storage (+44). Converted into costs, the small difference in CO2e did not change the estimated cost difference of €249 in favor of RPM. In the MCDA the environmental impact criterion received the lowest importance-weight, and the value score was 0.74 for RPM and 0.65 for UC.

CONCLUSIONS: The difference in CO2e between interventions needs to be substantial to change the results of a CUA. This also applies to the MCDA, unless the environmental impact criterion gets a larger weight.