P1639 Outcomes and costs of remote patient monitoring among patients with implanted cardiac defibrillators: an economic model based on the PREDICt RM database

Abstract

Funding Acknowledgements: Boston Scientific Introduction: Remote patient monitoring (RPM) of implantable cardioverter-defibrillators (ICD) has been associated with reduced rates of all-cause rehospitalizations and mortality but continues to be underutilized. To determine if RPM has economic benefits in addition to clinical benefits, we conducted an analysis of the clinical outcomes and costs of RPM versus no RPM. Purpose: We hypothesized that use of RPM is associated with better health outcomes and lower hospitalization costs over the lifetimes of ICD recipients. Methods: An economic model was used to simulate individual patients using a time-to-event approach to evaluate the clinical outcomes and costs of RPM from a US Medicare perspective. Events considered were first rehospitalization, subsequent rehospitalizations, and death. Patient characteristics and clinical inputs to the model were taken from the Medicare cohort of the PREDICT RM database, created by linking the ACCF ICD Registry, the Boston Scientific ALTITUDE RPM database, and Medicare claims data. Times to first rehospitalization and death were extrapolated using regression analyses based on patient characteristics and, for mortality, history of first rehospitalization. Hospitalization costs by DRG were obtained from the Medicare 2016 Inpatient Prospective Payment System. DRG codes were mapped to ICD-9 codes to assign utility decrements. Costs and benefits were discounted at 3.5% per year. The model assumed a lifetime time horizon up to 25 years. Results: Use of RPM was associated with reduced mortality. With RPM, average life expectancy increased from 6.37 to 7.08 years (8.5 months), and average quality-adjusted life years (QALYs) increased from 5.26 to 5.85 (7.1 months). RPM patients had 0.05 fewer subsequent rehospitalizations per patient-year (PY), and hospitalization costs were lower by $716/PY. With longer life expectancies, however, the average RPM patient experienced 0.64 additional subsequent rehospitalizations with an increased lifetime hospitalization cost of $2,784. This yields an incremental cost-effectiveness ratio of $4,718/QALY, making RPM a high-value intervention based on the ACC/AHA 2014 consensus statement. Conclusions: Use of RPM is associated with better health outcomes and value over a patient’s lifetime.