Author + information
- Laurence Guédon-Moreau,
- Dominique Lacroix,
- Nicolas Sadoul,
- Jacques Clémenty,
- Claude Kouakam,
- Jean Sylvain Hermida,
- Etienne Aliot and
- Salem Kacet
The randomized ECOST study confirmed the safety and effectiveness of long-term remote monitoring (RM) of implantable cardioverter defibrillators (ICD). We compared the overall costs of RM with those of ambulatory follow-up (AFU) on the long term.
ECOST randomly assigned 433 ICD recipients to RM versus AFU. Patients assigned to RM were seen once a year unless the system reported an ICD dysfunction or a clinical event mandating an ambulatory visit. Patients assigned to AFU were seen in the ambulatory department every 6 months. This analysis included 310 patients. Instead of using the expected costs based on a theorical act schedule, we calculated and compared the long-term individual costs associated with each follow-up strategy, using the actual billing documents issued by the French national health insurance system, including 1) costs of non-hospital care (all cardiovascular procedures, all ICD-related or unrelated ambulatory visits and ICD associated transportation costs) and 2) costs of hospitalizations for management of cardiovascular disorders.
The characteristics of the study groups were similar. Over a follow-up of 27 months, the mean costs (± standard deviation) of non-hospital care were €568 ± 349 per patient-year in the RM, versus €712 ± 414 per patient-year in the AFU group, a €144 per patient-year (20%) cost saving (p<0.001). The mean costs of hospitalizations per patient-year for management of cardiovascular disorders in the RM (€2,829 ± 6,382) versus the AFU (€3,549 ± 9,714) group were similar.
In this initial randomized comparison, which did not include the costs of the RM system and of ICD, the costs of non-hospital, long-term RM of ICD were significantly lower than the costs of AFU.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: Devices IV – Ethical and Economic Issues Related to Arrhythmia Devices
Abstract Category: 8. Arrhythmias: Devices
Presentation Number: 1277-30
- 2013 American College of Cardiology Foundation