Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
The European Journal of Health Economics
Published in: The European Journal of Health Economics 7/2017

Open Access 01-09-2017 | Original Paper

Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort

Authors: Dmitrij Achelrod, Jonas Schreyögg, Tom Stargardt

Published in: The European Journal of Health Economics | Issue 7/2017

Login to get access

Abstract

Introduction

Telemonitoring for COPD has gained much attention thanks to its potential of reducing morbidity and mortality, healthcare utilisation and costs. However, its benefit with regard to clinical and economic outcomes remains to be clearly demonstrated.

Objective

To analyse the effect of Europe’s largest COPD telemonitoring pilot project on direct medical costs, health resource utilisation and mortality at 12 months.

Methods

We evaluated a population-based cohort using administrative data. Difference-in-difference estimators were calculated to account for time-invariant unobservable heterogeneity after removing dissimilarities in observable characteristics between the telemonitoring and control group with a reweighting algorithm.

Results

The analysis comprised 651 telemonitoring participants and 7047 individuals in the standard care group. The mortality hazards ratio was lower in the intervention arm (HR 0.51, 95 % CI 0.30–0.86). Telemonitoring cut total costs by 895 € (p < 0.05) compared to COPD standard care, mainly driven by savings in COPD-related hospitalisations in (very) severe COPD patients (−1056 €, p < 0.0001). Telemonitoring enrolees used healthcare (all-cause and COPD-related) less intensely with shorter hospital stays, fewer inpatient stays and smaller proportions of people with emergency department visits and hospitalisations (all p < 0.0001). Reductions in mortality, costs and healthcare utilisation were greater for (very) severe COPD cases.

Conclusion

This is the first German study to demonstrate that telemonitoring for COPD is a viable strategy to reduce mortality, healthcare costs and utilisation at 12 months. Contrary to widespread fear, reducing the intensity of care does not seem to impact unfavourably on health outcomes. The evidence offers strong support for introducing telemonitoring as a component of case management.
Appendix
Available only for authorised users
Literature
1.
Decramer, M., Janssens, W., Miravitlles, M.: Chronic obstructive pulmonary disease. Lancet 379, 1341–1351 (2012)CrossRefPubMed
2.
Menn, P., Heinrich, J., Huber, R.M., Jörres, R.A., John, J., Karrasch, S., Peters, A., Schulz, H., Holle, R.: KORA Study Group: direct medical costs of COPD—an excess cost approach based on two population-based studies. Respir. Med. 106, 540–548 (2012)CrossRefPubMed
3.
Geldmacher, H., Biller, H., Herbst, A., Urbanski, K., Allison, M., Buist, A.S., Hohlfeld, J.M., Welte, T.: The prevalence of chronic obstructive pulmonary disease (COPD) in Germany. Results of the BOLD study. Dtsch. Med. Wochenschr. 133, 2609–2614 (2008)CrossRefPubMed
4.
Pritzkuleit, R., Beske, F., Katalinic, A.: Disease numbers in pneumology—a projection to 2060. Pneumologie 64, 535–540 (2010)CrossRefPubMed
5.
6.
Achelrod, D.: Policy expectations and reality of telemedicine—a critical analysis of health care outcomes, costs and acceptance for congestive heart failure. J. Telemed. Telecare 20, 192–200 (2014)CrossRefPubMed
7.
Bolton, C.E., Waters, C.S., Peirce, S., Elwyn, G.: EPSRC and MRC Grand Challenge Team: insufficient evidence of benefit: a systematic review of home telemonitoring for COPD. J. Eval. Clin. Pract. 17, 1216–1222 (2011)CrossRefPubMed
8.
McLean, S., Nurmatov, U., Liu, J.L.Y., Pagliari, C., Car, J., Sheikh, A.: Telehealthcare for chronic obstructive pulmonary disease: Cochrane review and meta-analysis. Br. J. Gen. Pract. 62, e739–e749 (2012)CrossRefPubMedPubMedCentral
9.
Cruz, J., Brooks, D., Marques, A.: Home telemonitoring effectiveness in COPD: a systematic review. Int. J. Clin. Pract. 68, 369–378 (2014)CrossRefPubMed
10.
Polisena, J., Tran, K., Cimon, K., Hutton, B., McGill, S., Palmer, K., Scott, R.E.: Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis. J. Telemed. Telecare 16, 120–127 (2010)CrossRefPubMed
11.
Pedone, C., Lelli, D.: Systematic review of telemonitoring in COPD: an update. Pneumonol. Alergol. Pol. 83, 476–484 (2015)CrossRefPubMed
12.
Henderson, C., Knapp, M., Fernández, J.-L., Beecham, J., Hirani, S.P., Cartwright, M., Rixon, L., Beynon, M., Rogers, A., Bower, P., Doll, H., Fitzpatrick, R., Steventon, A., Bardsley, M., Hendy, J., Newman, S.P.: Whole system demonstrator evaluation team: cost effectiveness of telehealth for patients with long-term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ 346, f1035 (2013)CrossRefPubMed
13.
Stoddart, A., van der Pol, M., Pinnock, H., Hanley, J., McCloughan, L., Todd, A., Krishan, A., McKinstry, B.: Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial. J. Telemed. Telecare 21, 108–118 (2015)CrossRefPubMed
14.
Hofer, F., Achelrod, D., Stargardt, T.: Cost-utility analysis of telemonitoring interventions for patients with chronic obstructive pulmonary disease (COPD) in Germany. Appl. Health Econ. Health Policy (2016). doi:10.​1007/​s40258-016-0267-9
15.
Federal Statistical Office: Population and employment—life table Germany 2009/11. Federal Statistical Office, Wiesbaden (2013)
16.
Hainmueller, J.: Entropy balancing for causal effects: a multivariate reweighting method to produce balanced samples in observational studies. Polit. Anal. 20, 25–46 (2012)CrossRef
17.
Austin, P.C.: Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat. Med. 28, 3083–3107 (2009)CrossRefPubMedPubMedCentral
18.
Bertrand, M., Duflo, E., Mullainathan, S.: How much should we trust differences-in-differences estimates? Q. J. Econ. 119, 249–275 (2004)CrossRef
19.
Ringbaek, T., Seersholm, N., Viskum, K.: Standardised mortality rates in females and males with COPD and asthma. Eur. Respir. J. 25, 891–895 (2005)CrossRefPubMed
20.
Elixhauser, A., Steiner, C., Harris, D.R., Coffey, R.M.: Comorbidity measures for use with administrative data. Med. Care 36, 8–27 (1998)CrossRefPubMed
21.
Kuo, R.N., Dong, Y.-H., Liu, J.-P., Chang, C.-H., Shau, W.-Y., Lai, M.-S.: Predicting healthcare utilization using a pharmacy-based metric with the WHO’s anatomic therapeutic chemical algorithm. Med. Care 49, 1031–1039 (2011)CrossRefPubMed
22.
Austin, P.C., Stanbrook, M.B., Anderson, G.M., Newman, A., Gershon, A.S.: Comparative ability of comorbidity classification methods for administrative data to predict outcomes in patients with chronic obstructive pulmonary disease. Ann. Epidemiol. 22, 881–887 (2012)CrossRefPubMedPubMedCentral
23.
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.-C., Saunders, L.D., Beck, C.A., Feasby, T.E., Ghali, W.A.: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med. Care 43, 1130–1139 (2005)CrossRefPubMed
24.
Ten Have, T.R., Normand, S.L.T., Marcus, S.M., Brown, C.H., Lavori, P., Duan, N.: Intent-to-treat vs. non-intent-to-treat analyses under treatment non-adherence in mental health randomized trials. Psychiatr. Ann. 38, 772–783 (2008)CrossRefPubMedPubMedCentral
25.
Steventon, A., Bardsley, M., Billings, J., Dixon, J., Doll, H., Hirani, S., Cartwright, M., Rixon, L., Knapp, M., Henderson, C., Rogers, A., Fitzpatrick, R., Hendy, J., Newman, S.: Whole system demonstrator evaluation team: effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 344, e3874 (2012)CrossRefPubMedPubMedCentral
26.
De Toledo, P., Jiménez, S., del Pozo, F., Roca, J., Alonso, A., Hernandez, C.: Telemedicine experience for chronic care in COPD. IEEE Trans. Inf Technol. Biomed. 10, 567–573 (2006)CrossRefPubMed
27.
Bourbeau, J., Julien, M., Maltais, F., Rouleau, M., Beaupré, A., Bégin, R., Renzi, P., Nault, D., Borycki, E., Schwartzman, K., Singh, R., Collet, J.-P.: Chronic Obstructive Pulmonary Disease axis of the Respiratory Network Fonds de la Recherche en Santé du Québec: reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch. Intern. Med. 163, 585–591 (2003)CrossRefPubMed
28.
Trappenburg, J.C.A., Niesink, A., de Weert-van Oene, G.H., van der Zeijden, H., van Snippenburg, R., Peters, A., Lammers, J.-W.J., Schrijvers, A.J.P.: Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Telemed. J. E Health 14, 138–146 (2008)CrossRefPubMed
29.
McKinstry, B.: The use of remote monitoring technologies in managing chronic obstructive pulmonary disease. QJM 106, 883–885 (2013)CrossRefPubMed
30.
Zwerink, M., Brusse-Keizer, M., van der Valk, P.D.L.P.M., Zielhuis, G.A., Monninkhof, M., van der Palen, J., Frith, P.A., Effing, T.: Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 3, CD002990 (2014)
31.
Wilkinson, T.M.A., Donaldson, G.C., Hurst, J.R., Seemungal, T.A.R., Wedzicha, J.A.: Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 169, 1298–1303 (2004)CrossRefPubMed
32.
Paré, G., Poba-Nzaou, P., Sicotte, C., Beaupré, A., Lefrançois, É., Nault, D., Saint-Jules, D.: Comparing the costs of home telemonitoring and usual care of chronic obstructive pulmonary disease patients: a randomized controlled trial. Eur. Res. Telemed. 2, 35–47 (2013)CrossRef
33.
Haesum, L.K.E., Soerensen, N., Dinesen, B., Nielsen, C., Grann, O., Hejlesen, O., Toft, E., Ehlers, L.: Cost-utility analysis of a telerehabilitation program: a case study of COPD patients. Telemed. J. E Health 18, 688–692 (2012)CrossRefPubMed
34.
Pinnock, H., Hanley, J., McCloughan, L., Todd, A., Krishan, A., Lewis, S., Stoddart, A., van der Pol, M., MacNee, W., Sheikh, A., Pagliari, C., McKinstry, B.: Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial. BMJ 347, f6070 (2013)CrossRefPubMedPubMedCentral
35.
McLean, S., Chandler, D., Nurmatov, U., Liu, J., Pagliari, C., Car, J., Sheikh, A.: Telehealthcare for asthma: a Cochrane review. CMAJ 183, E733–E742 (2011)CrossRefPubMedPubMedCentral
36.
Anthonisen, N.R., Connett, J.E., Enright, P.L., Manfreda, J.: Lung Health Study Research Group: hospitalizations and mortality in the Lung Health study. Am. J. Respir. Crit. Care Med. 166, 333–339 (2002)CrossRefPubMed
37.
Achelrod, D., Welte, T., Schreyögg, J., Stargardt, T.: Costs and outcomes of the German disease management programme (DMP) for chronic obstructive pulmonary disease (COPD)—a large population-based cohort study. Health Policy (2016). doi:10.​1016/​j.​healthpol.​2016.​08.​002 (in press) PubMed
38.
Rubin, D.B.: Formal mode of statistical inference for causal effects. J. Stat. Plan. Inference. 25, 279–292 (1990)CrossRef
Metadata
Title
Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort
Authors
Dmitrij Achelrod
Jonas Schreyögg
Tom Stargardt
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 7/2017
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-016-0834-x

Other articles of this Issue 7/2017

The European Journal of Health Economics 7/2017 Go to the issue

Original Paper

Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany

Original Paper

The social cost of drugs in France in 2010

Original Paper

Measuring customer preferences in the German statutory health insurance

Original Paper

The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program

Editorial

On vaccination programs in the EU Member States: the case of the human papilloma virus

Original Paper

Age effects in mortality risk valuation