February 17, 2011
Eucomed has recently submitted remote monitoring of implantable cardiac devices as one of its four proposals to the Active and Healthy Ageing Innovation Partnership under the European Commission’s Innovation Union Strategy. Such an initiative is exactly what Europe is in need of to ensure its place at the top of the innovation ladder.
Eucomed selected remote monitoring of implantable cardiac devices as one of its submissions to the Consultation because we believe this form of treatment has not only the potential to significantly improve chronic cardiac care but also because this treatment can potentially save billions of Euros. But don’t take my word for it…
A recent report by Klersy and colleagues1 looked into remote care applications for the treatment of chronic heart failure. One important component of heart failure care consists of protecting the patient from moving into acute cardiac decompensation, leading to emergency admissions to the hospital. Therefore, regular, close monitoring of the patient is essential. Traditionally, this monitoring involved frequent visits to the doctor’s office or outpatient clinic. Alternatively patients can also be monitored from the convenience of their own home, either through regular, structured phone conversations with the healthcare provider, or through an approach that relies on information technology to transfer between patient and doctor physiological data collected via external monitors or from the patient’s cardiovascular implant.
So what about the outcome? Klersy studied 21 randomised-controlled trials comparing both approaches to heart failure management. Over a one-year period they found that, in the traditional care group, 42% of the patients had been admitted to hospital for their heart failure, compared to only 29.5% of patients in the remote monitoring group.
Regarding costs, the report concludes that, over a one-year period, a patient in the remote monitoring group saves on average around €450 compared to patients in the traditional heart failure management group, in some countries even up to €1,000. When a certain therapy not only delivers better outcomes, but also saves costs, health economists refer to it as a “dominant therapy alternative”.
Obviously, there are a few shortcomings with the model put forward by Klersy, one of which being the fact that the implementation costs of remote monitoring technology were not taken into account. However, to the authors it is “evident that the savings generated for the third-party payer by implementing the Remote Patient Monitoring approach could be used to partly or completely cover the implementation costs”. Crudely extrapolating these individual savings to a large-scale implementation would deliver substantial cost savings: If we assume that there are 12.5 million heart failure patients in the EU27, the reported savings of €450 per patient would amount to about €5.6 billion per year!
The research by Klersy and colleagues finds that the lack of appropriate reimbursement systems to cover the costs for remote monitoring is the main stumbling block to wide-spread adoption of remote monitoring solutions. And yes, establishing permanent reimbursement mechanisms for the remote monitoring activities would then again eat away some of the above savings, but certainly not all of them. On balance, the economic potential remains interesting from a societal perspective. And let’s not forget the improvements in clinical care and patient quality of life!
Our expectations at Eucomed are therefore high that the Active and Health Ageing Innovation Partnership will help to overcome the current implementation hurdles and make the considerable potential of remote monitoring of European Heart Failure patients a less remote reality.
– Markus Siebert
Chair of Eucomed Cardiac Rhythm Management Telemonitoring Group
1 European Journal of Heart Failure, doi:10.1093/eurjhf/hfq232