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.

中文翻译：

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一项随机试验中针对炎症性肠病患者的远程医疗指导的专业护理与标准护理的成本效益。

背景与目标

远程医疗可用于监测慢性病患者的决定因素和结果，可能会提高护理的质量和价值。发现远程医疗可以减少炎症性肠病 (IBD) 患者的门诊就诊次数和住院次数。我们对 IBD 患者的远程医疗干预进行了全面的经济评估，比较了远程医疗与标准护理的成本效用。

方法

我们在荷兰的 2 家学术医院和 2 家非学术医院对 909 名 IBD 患者进行了一项随机试验。患者被随机分配到接受远程医疗（myIBDcoach；n = 465）或标准门诊护理（n = 444）的组中，并随访 12 个月。成本是从社会角度衡量的。直接医疗保健费用基于实际资源使用。间接成本包括自我报告的病假时间、干预成本（每位患者每年 40 欧元的许可费 [45 美元]）和公用事业成本（使用 EQ5D 评估）。使用非参数引导法估计成本效用和不确定性。

结果

远程医疗使每位患者的平均年度成本降低了 547 欧元 [612 美元]（95% CI，1029-2143 欧元 [1150-2393 美元]；标准护理的平均成本为 9481 欧元 [10,587 美元]，远程医疗的平均成本为 8924 欧元 [9965 美元]）不改变质量调整寿命年。在每质量调整生命年 80,000 欧元 [$89,335] 的荷兰阈值下，该干预措施在 83% 的重复中增加了超过标准护理的增量成本效益，并增加了 707 欧元/患者 [$790]（95% CI , €1241–2544 [$1386-2841])。

结论

使用 myIBDcoach 进行远程医疗可以节省成本，并且很有可能对 IBD 患者具有成本效益。这种自我管理工具可以连续注册质量指标和（患者报告的）结果，并可能有助于将 IBD 护理重组为基于价值的医疗保健。ClinicalTrials.gov 编号：NCT02173002。