The impact of adherence on costs and effectiveness of telemedical patient management in heart failure

Summary

Objective: This paper analyzes evidence of the impact of patients’ adherence to pharmacological and non-pharmacological recommendations on the treatment costs of heart failure (HF) patients.

Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were searched using various combinations of the following keywords: ‘telemedicine’, ‘telemonitoring’, ‘telehealth’, ‘eHealth’, ‘remote monitoring’, ‘adherence’, ‘compliance’, ‘cost-effectiveness’, ‘cost-benefit’, ‘heart failure’, ‘healthcare costs’, ‘hospitalization’, and ‘drug costs’. We included only papers written in English or German, published between 1998 and 2014, and having one of our search terms in the title.

Results: Initially, 73 papers were selected. After a detailed review, these were narrowed done to 9 that reported an association between adherence and/or compliance and costs. However, none established a quantitative relationship between adherence and total healthcare costs.

Conclusion: A model-based cost-effectiveness analysis that appropriately considers adherence has not been carried out so far, but is needed to fully understand the potential economic benefits of telehealth.

Citation: Hameed AS, Sauermann S, Schreier G. The impact of adherence on costs and effectiveness of telemedical patient management in heart failure: A systematic review. Appl Clin Inf 2014; 5: 612–620

http://dx.doi.org/10.4338/ACI-2014-04-RA-0037

Keywords

Telemedicine - mHealth - therapy adherence/compliance - cost-effectiveness - heart failure

 

Conflicts of interest

The authors declare that they have no conflicts of interest in the research.

• References

• 1 Bundesministerium für Gesundheit.. Bundes-Zielsteuerungsvertrag. Nr. 986167_B-ZV_26062013 [Internet]. 2013 Jun [zitiert 2013 Okt. 20]. Erreichbar unter: http://www.hauptverband.at/mediaDB 986167_B-ZV_26062013_Letztfassung_Unterschrieben.pdf. German.
• 2 Brussels.. European Commission. E-Health Action Plan 2012–2020: Innovative healthcare for the 21st century. 2012 Dec. Report Nr. COM (2012) 736 final.
• 3 Sabate E. World Health Organization, Geneva (Switzerland). Adherence to long-term therapies: evidence for action. 2003. ISBN 9241545992.
• 4 O’Neill K. U. S. Surgeon general joins Baltimore launch of the National Script Your Future Campaign to highlight importance of taking medication as directed [Internet]. 2011 Nov [cited 2014 Jan. 23]. Available from: http://scriptyourfuture.org/wp-content/themes/cons/m/release.pdf
• 5 AIT [Internet].. Vienna. Pressegespräch: Herzschwäche-bessere Prognose durch Telemedizin; 14.3.2013. [zitiert 2014 Jan. 05]. Erreichbar unter: http://www.ait.ac.at/news-events/single-view ?no_cache=1&tx_ttnews[tt_news]=1472. German.
• 6 Schreier G, Eckmann H, Hayn D, Kreiner K, Kastner P, Lovell N. Web versus App –compliance of patients in a telehealth diabetes management programme using two different Technologies. J of Telemedicine and Telecare 2012; 18: 476-480.
• 7 Ramaekers BL, Janssen-Boyne JJ, Gorgels AP, Vrijhoef HJ. Adherence among telemonitored patients with heart failure to pharmacological and nonpharmacological recommendations. Telemedicine and e-Health 2009; 15 (06) 517-524.
• 8 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [Internet].. PRISMA Statement. [cited 2014 Jan. 10]. Available from: http://www.prisma-statement.org
• 9 PubMed Database [Internet].. National Centre for Biotechnology Information. Available from: http://www.ncbi.nlm.nih.gov/pubmed
• 10 Google Scholar [Internet].. Available from: http://scholar.google.com
• 11 Banka G, Heidenreich PA, Fonarow GC. Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. JACC 2013; 20 (010) 1-7.
• 12 Chen YH, Lin YH, Hung CS, Huang CC, Yeih DF, Chuang PY, Ho YL, Chen MF. Clinical outcome and cost-effectiveness of a synchronous telehealth service for seniors and nonseniors with cardiovascular diseases: quasi-experimental study. JMIR 2013; 15 (04) e87.
• 13 De Lusignan S, Wells S, Johnson P, Meredith K, Leatham E. Compliance and effectiveness of 1 year’s home telemonitoring. The report of a pilot study of patients with chronic heart failure. Europ J of HF 2001; 3: 723-730.
• 14 Guzman-Clark JR, van Servellen G, Chang B, Mentes J, Hahn TJ. Predictors and outcomes of early adherence to the use of a home telehealth device by older veterans with heart failure. Telemedicine and e-Health 2013; 19 (03) 217-223.
• 15 Heinen-Kammerer T, Kiencke P, Motzkat K, Neller S, Liecker B, Petereit F, Hecke T, Müller H, Rychlik R. Telemedizin in der Tertiärprävention: Wirtschaftlichkeitsanalyse des Telemedizin-Projektes Zertiva bei Herzinsuffizienz-Patienten der Techniker Krankenkasse. Springer Berlin Heidelberg; 2006. pp 531-549. German.
• 16 Pandor A, Thokala P, Gomersall T, Baalbaki H, Stevens JW, Wang J, Wong R, Brennan A, Fitzgerald P. Home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation. HTA; 2013. 17(32).
• 17 Rohde LE, Bertoldi EG, Goldraich L, Polanczyk CA. Cost-effectiveness of heart failure therapies. Nature reviews/Cardiology 2013; 10 (06) 338-354.
• 18 Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication Aadherence on hospitalization risk and healthcare cost. Medical Care 2005; 43 (06) 521-530.
• 19 Dávalos ME, French MT, Burdick AE, Simmons SC. Economic evaluation of telemedicine: review of the literature and research guidelines for benefit –cost analysis. Telemedicine and e-Health 2009; 15 (10) 933-948.
• 20 Ploier M. E-Health und Telemedizin: Haftungsfragen. J Hyperton. 2011 15 (1).
• 21 Statistics Austria, Population forecasts [Internet], 2013.. Oct. Report: results_overview_austria_029024. Available from: https://www.statistik.at/web_en/statistics/population/demographic_forecasts/popu lation_forecasts/index.html
• 22 Austrian federal ministry of health.. Gesundheit Österreich GmbH, editor. Financing and expenditure, in: The Austrian healthcare system, Key facts 2010, June 2010 p18–21. ISBN 978–3–902611–38–3