Results from the EuroEco trial have found that the cost of remote monitoring (with Biotronik Home Monitoring) of patients with implantable cardioverter defibrillators (ICDs)-to physicians, hospitals and insurance providers-does not differ significantly from traditional in-office monitoring. However, the EuroEco study also identified European variations in the financial burden that physicians and hospitals face in switching to this approach, due to national differences in insurance reimbursement.
The EuroEco (European health economic trial on Home Monitoring in ICD therapy), was presented at a Hot Line session of the European Society of Cardiology (ESC) congress (Barcelona, Spain, 29 August – 2 September) and was simultaneously published in the European Heart Journal.
Hein Heidbuchel (Hasselt University and Heart Center Hasselt, Belgium) principal investigator and presenter of the study, told delegates: “We have remote monitoring of implantable cardiac devices for about ten years and all stakeholders see potential benefits. Patients feel more reassured, physicians and hospitals see a way to optimise the way they deliver care and for the payers of healthcare there might be a dominant strategy in there.” Nevertheless, he said, “there is not a formal cost-analysis available from the provider [physicians and hospitals] perspective that has ever been performed.” Therefore, the main objective of this trial was to evaluate the cost to physicians and hospitals when relying on Home Monitoring-based follow-up compared to in-office follow-up.
EuroEco was a randomised, controlled, non-blinded trial, which included 17 centres from Belgium, Germany, Great Britain, Spain, and The Netherlands. Three hundred and three patients (average age 62.4 years, 81% male) were enrolled to receive a single- or dual-chamber ICD equipped with Home Monitoring technology. Of those, 159 had Home Monitoring activated (HM On) and 144 did not (HM Off), but had routine in-office visits scheduled throughout the study. All patients were followed for two years. Over the study period, patients in both groups had three mandatory in-office follow-up visits (six weeks, and one and two years after discharge), with unscheduled visits, either physician- or patient-initiated, allowed at any time.
A total of 242 patients completed the study as planned, with a mean follow-up period of 21.8 months. Premature discontinuation was mainly related to death. Heidbuchel noted that there is an extended cohort studying cardiac resynchronisation therapy (CRT) patients (n=104), which is still enrolling.
Heidbuchel explained that across the entire study, the total follow-up cost for providers (the primary endpoint of the trial) was not different for HM On vs. HM Off (mean €204 vs. €213, respectively), neither was their net profit (€408 vs. €400). For insurers, the total cost per patient (including other physician visits, examinations and hospitalisations) was numerically (but not significantly) lower for HM On patients, mainly as a result of less hospitalisations and shorter length-of-stay.
Despite a significantly higher number of office visits that were unscheduled in the HM On group compared to the HM Off group, the total number of visits was still significantly lower for HM On compared to HM Off patients (3.79 vs. 5.53, p<0.001). Patient self-reported quality of life was not different between the two groups.
Overall, the same amount of staff time was required for both groups during the study period (176 minutes for HM On patients vs. 178 minutes for HM Off patients), with physicians being the only staff who needed significantly less time for HM On patients, although the absolute difference was small (64 vs. 73 minutes, p=0.028).
Regarding the results of the country-dependent analysis, Heidbuchel noted that in Belgium, Spain and The Netherlands there is no reimbursement for remote monitoring, whereas in Germany and the United Kingdom reimbursement exists. In the countries with reimbursement, Heidbuchel said, Home Monitoring providers brought in less profit because of a lack of reimbursement, while in Germany and the UK, Home Monitoring was associated with maintained or increased profit. Nevertheless, total payer costs did not increase in any country.
“Reimbursement protects income for physicians and hospital, creating an incentive to adopt remote monitoring. EuroEco shows that this is possible without increased overall costs to insurers, which is a strong argument for reimbursing remote monitoring,” noted Heidbuchel.
In conclusion, he said: “EuroEco may provide data that facilitates discussions towards balanced reimbursement benefiting all players: industry, physicians and insurers and at the end providing patients with more continues care.”