Long-term effects of telemonitoring on healthcare usage in patients with heart failure or COPD

Abstract

Background: Heart failure and chronic obstructive pulmonary disease (COPD) are leading causes of disability and lead to substantial healthcare costs. The aim of this study was to evaluate the effectiveness of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or COPD. Methods: The study was a retrospective observational study with a follow-up duration of up to 3 years in which for all participants data before and after enrollment in the telemonitoring program was compared. Hundred seventy-seven patients with heart failure (NYHA functional class 3 or 4) and 83 patients with COPD (GOLD stage 3 or 4) enrolled in a home telemonitoring program in addition to receiving usual hospital care. The primary outcome was the number of hospitalizations; the secondary outcomes were total number of hospitalization days and healthcare costs during the follow-up period. Generalized Estimating Equations were applied to account for repeated measurements, adjusting for sex, age and length of follow-up. Results: In heart failure patients, after initiation of home telemonitoring both the number of hospitalizations and the total number of hospitalization days significantly decreased (incidence rate ratio of 0.35 (95% CI: 0.26–0.48) and 0.35 (95% CI: 0.24–0.51), respectively), as did the total healthcare costs (exp(B) = 0.11 (95% CI: 0.08–0.17)), all p < 0.001. In COPD patients neither the number of hospitalizations nor the number of hospitalization days changed compared to the pre-intervention period. However, the healthcare costs were about 54% lower in COPD patients after the start of the telemonitoring intervention (exp(B) = 0.46, 95% CI 0.25–0.84, p = 0.011). Conclusions: Integrated home telemonitoring significantly reduced the number of hospital admissions and days spent in hospital in patients with heart failure, but not in patients with COPD. Importantly, in both patients with heart failure and COPD the intervention substantially reduced the total healthcare costs.