OBJECTIVES

To estimate from the payer perspective, the cost and clinical consequences of a Remote Patient Monitoring (RPM) standardized program, supported in Claria Sharesource technology, to improve the clinical practice and control of incident patients in automatized peritoneal dialysis (APD) in Brazil.

METHODS

A one year Markov analytic model, structured in five health states, was used to project costs and clinical outcomes from a cohort of 100 APD patients with and without RPM. Rates of hospitalization, peritonitis, technique failure and mortality were estimated from medical literature. Dialysis ambulatory costs were estimated from referent national tariffs CBHPM. Inpatient care costs were obtained from SIMPRO, CMED, CBHPM and UNIDAS. Complication costs were estimated from medical literature and expert opinion. Model results were reported as the RPM incremental effect in: overall direct costs, time free of complications, one year persistence in APD, hospitalization episodes, days of hospitalization, peritonitis episodes, technique failure episodes and death episodes. Both deterministic and probabilistic sensitivity analyses were done to analyze the effect of parameter estimation uncertainty in the model.

RESULTS

In comparison with APD without RPM, the implementation of a RPM program in 100 APD patients during one year resulted in: Overall savings USD $ 435,606; 36 additional patients months free of complications; 28 hospitalization episodes avoided; 506 hospitalization days avoided; 9 other complications avoided. Deterministic sensitivity analysis: RPM tariff, hospitalization rate and hospitalization episode costs were the most sensitive drivers of model results. Probabilistic sensitivity analysis: With more than 90% of chance, the RPM standardized program was a cost-saving dominant intervention.

CONCLUSIONS

From the payer perspective, RPM could be a cost saving dominant alternative, improving patient time in control, burden of hospitalization and complications.