Telemonitoring of patients with COPD reduces mortality with neutral effect on total costs: evidence from a real world data analysis over three years

Introduction: Chronic obstructive pulmonary disease (COPD) affects more than 6 million people in Germany. The remote monitoring of vital parameters of COPD patients via telemonitoring (TM) is expected to prevent or contain acute deterioration of the patientʼs health and thus to improve the provision of health care while saving costs for sickness funds.

Objective: To evaluate the effects of a structured home TM program implemented by a German sickness fund for up to 3 years.

Methods: We conducted a retrospective cohort study using administrative data. After building a synthetic control group using entropy balancing, difference-in-difference estimators were calculated to account for time-invariant heterogeneity. Differences in mortality rates were estimated using Cox regression. Subgroup and sensitivity analyses were performed to check the robustness of the base case results.

Results: We observed a significant increase in outpatient contacts in the first two years (0.875, p < 0.01; 0.738, p < 0.05) and a higher number of drug prescriptions in all three years of the TM program for the TM cohort (2.050, p < 0.05; 2.726, p < 0.03; 3.317, p < 0.05). While we found virtually no differences in health care expenditure across patients, we found significantly improved survival rates for participants of the TM program (HR 0.68, p < 0.001). If analysed by GOLD status, there was a tendency for savings in GOLD 1 and GOLD 2 TM patients while GOLD 3 – the majority of the cohort – and GOLD 4 TM patient tended to incur higher costs.

Conclusion: We found no statistically significant differences regarding costs between the TM and the weighted control groups, but an increase of outpatient contacts and drug subscriptions for individuals participating in the monitoring program. Furthermore, we found the TM program to be accompanied by a survival benefit which might be related to higher adherence rates, a more intense treatment or a better understanding of COPD by patients.