Cost-effectiveness of Telemedicine-directed Specialized vs Standard Care for Patients With Inflammatory Bowel Diseases in a Randomized Trial.
Clin Gastroenterol Hepatol
; 18(8): 1744-1752, 2020 07.
Article
in En
| MEDLINE
| ID: mdl-32335133
ABSTRACT
BACKGROUND & AIMS:
Telemedicine can be used to monitor determinants and outcomes of patients with chronic diseases, possibly increasing the quality and value of care. Telemedicine was found to reduce outpatient visits and hospital admissions for patients with inflammatory bowel diseases (IBD). We performed a full economic evaluation of telemedicine interventions in patients with IBD, comparing the cost-utility of telemedicine vs standard care.METHODS:
We performed a randomized trial of 909 patients with IBD at 2 academic and 2 non-academic hospitals in The Netherlands. Patients were randomly assigned to groups that received telemedicine (myIBDcoach; n = 465) or standard outpatient care (n = 444) and followed for 12 months. Costs were measured from a societal perspective. Direct healthcare costs were based on actual resource use. Indirect costs comprised self-reported hours sick leave from work, intervention costs (annual license fee of 40 per patient [$45]), and utility costs (assessed using EQ5D). Cost-utility and uncertainty were estimated using the non-parametric bootstrapping method.RESULTS:
Telemedicine resulted in lower mean annual costs of 547/patient [$612] (95% CI, 1029-2143 [$1150-2393]; mean costs of 9481 [$10,587] for standard care and 8924 [$9965] for telemedicine) without changing quality adjusted life years. At the Dutch threshold of 80,000 [$89,335] per quality adjusted life year, the intervention had increased incremental cost-effectiveness over standard care in 83% of replications and an incremental net monetary benefit of 707/patient [$790] (95% CI, 1241-2544 [$1386-2841]).CONCLUSIONS:
Telemedicine with myIBDcoach is cost saving and has a high probability of being cost effective for patients with IBD. This self-management tool enables continuous registration of quality indicators and (patient-reported) outcomes and might help reorganize IBD care toward value-based healthcare. ClinicalTrials.gov no NCT02173002.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Inflammatory Bowel Diseases
/
Telemedicine
Type of study:
Clinical_trials
/
Health_economic_evaluation
Aspects:
Patient_preference
Limits:
Humans
Language:
En
Journal:
Clin Gastroenterol Hepatol
Journal subject:
GASTROENTEROLOGIA
Year:
2020
Document type:
Article