Marin J de Jong1, Annelies Boonen2, Andrea E van der Meulen-de Jong3, Mariëlle J Romberg-Camps4, Ad A van Bodegraven4, Nofel Mahmmod5, Tineke Markus6, Gerard Dijkstra7, Bjorn Winkens8, Astrid van Tubergen2, Ad Masclee9, Daisy M Jonkers1, Marie J Pierik10. 1. Maastricht University Medical Centre+, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht; Maastricht University Medical Centre+, NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht. 2. Maastricht University Medical Centre+, Department of Internal Medicine, Division of Rheumatology, Maastricht; Maastricht University Medical Centre+, CAPHRI - Care and Public Health Research Institute, Maastricht. 3. Leiden University Medical Centre, Department of Gastroenterology and Hepatology, Leiden. 4. Zuyderland Medical Centre, Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Sittard-Geleen. 5. St Antonius Hospital, Department of Gastroenterology and Hepatology, Nieuwegein. 6. Dutch Crohn's and Colitis Organisation, CCUVN, Woerden. 7. University Medical Centre Groningen, Department of Gastroenterology and Hepatology, Groningen. 8. Maastricht University Medical Centre+, CAPHRI - Care and Public Health Research Institute, Maastricht; Maastricht University, Department of Methodology and Statistics, Maastricht, Netherlands. 9. Maastricht University Medical Centre+, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht; Zuyderland Medical Centre, Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Sittard-Geleen. 10. Maastricht University Medical Centre+, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht; Maastricht University Medical Centre+, NUTRIM - School for Nutrition and Translational Research in Metabolism, Maastricht. Electronic address: m.pierik@mumc.nl.
Abstract
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.
RCT Entities:
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.
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