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Telemonitoring in patients with heart failure, a health economic evaluation and decision analysis

Ekkel, Danielle (2010) Telemonitoring in patients with heart failure, a health economic evaluation and decision analysis.

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Abstract:Background: Telemonitoring for the management of congestive heart failure (CHF) is regarded as a promising innovation for dealing with the economic burden of this chronic disease. However, its widespread adoption into practice has not yet been achieved. Recent studies call for more rigorous economic evaluations on which decision makers can base their decision whether or not to adopt telemonitoring in practice. However, how important is evidence on cost-effectiveness actually in this kind of decision making and which other factors are considered? - Objective: The objective of this research was twofold. The first objective was to investigate the costeffectiveness of a telemonitoring system for CHF patients in order to add a good methodological economic evaluation to existing evidence. The second objective was to analyse the relative importance of economic outcomes and other factors in decision making regarding the adoption of telemonitoring in CHF. Combined, findings allow to eventually predict how likely it is that the telemonitoring system as evaluated in the economic analysis, will be adopted by involved takeholders. - Method: A health economic evaluation was performed alongside a randomized controlled trial (RCT) as conducted by the Maastricht University Medical Centre. This RCT was a prospective, two-arm, open-label randomized controlled trial, carried out at three hospitals in the South Limburg area in the Netherlands and conducted with a follow-up period of 12 months. 382 patients with HF were randomized to receive care using telemonitoring or usual care. The telemonitoring system patients used was the Health Buddy®. The health economic evaluation used a health system perspective and was based on chronic care management evaluation frameworks. The primary outcome measure was cost-effectiveness. For the second objective of this study a multi criteria decision analysis (MCDA) was conducted. Through the analytic hierarchy process (AHP) with 7 respondents, the relative importance was determined of several criteria considered in decision making regarding telemonitoring. Respondents were stakeholders involved with telemonitoring in CHF, operation at the local level. In addition, group and individual interviews were conducted to examine arguments for the hierarchy given to the criteria. - Results: Results of the health economic evaluation are currently confidential. The MCDA showed that effectiveness and cost-effectiveness appeared to be important factors in decision making regarding the adoption of telemonitoring. Other factors like safety; budget impact; patient and professional satisfaction; and financing were also considered important in decision making. Stakeholders assigned the highest relative weight to safety. Conclusion: The more telemonitoring proves to be cost-effective, the greater the chance that it will be adopted into practice, as effectiveness and cost-effectiveness are considered important criteria in decision making.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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