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Aritmologia in Campania

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Il monitoraggio remoto, per il follow-up di portatori di pacemaker e defibrillatori, riduce le spese del servizio sanitario nazionale per il paziente

Alessandro Capucci, Antonio De Simone, Mario Luzi, Valeria Calvi, Giuseppe Stabile, Antonio D’Onofrio, Simone Maffei, Loira Leoni, Giovanni Morani, Raffaele Sangiuolo, Claudia Amellone, Catia Checchinato, Ernesto Ammendola, and Gianfranco Buja

Aims
Heart failure (HF) patients with implantable cardioverter-defibrillators (ICD) require admissions for disease management
and out-patient visits for disease management and assessment of device performance. These admissions
place a significant burden on the National Health Service. Remote monitoring (RM) is an effective alternative to
frequent hospital visits. The EFFECT study was a multicentre observational investigation aiming to evaluate the clinical
effectiveness of RM compared with in-office visits standard management (SM). The present analysis is an economic
evaluation of the results of the EFFECT trial.
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Methods and results
The present analysis considered the direct consumption of healthcare resources over 12-month follow-up.
Standard tariffs were applied to hospitalizations, in-office visits and remote device interrogations. Economic comparisons
were also carried out by means of propensity score (PS) analysis to take into account the lack of randomization
in the study design. The analysis involved 858 patients with ICD or CRT-D. Of these, 401 (47%) were
followed up via an SM approach, while 457 (53%) were assigned to RM. The rate of hospitalizations was 0.27/year
in the SM group and 0.16/year in the RM group (risk reduction =0.59; P = 0.0004). In the non-adjusted analysis, the
annual cost for each patient was e817 in the SM group and e604 in the RM group (P = 0.014). Propensity score
analysis, in which 292 RM patients were matched with 292 SM patients, confirmed the results of the non-adjusted
analysis (e872 in the SM group vs. e757 in the RM group; P < 0.0001).
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Conclusion
There is a reduction in direct healthcare costs of RM for HF patients with ICDs, particularly CRT-D, compared
with standard monitoring.
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Clinical Trial Registration
http://clinicaltrials.gov/Identifier, NCT01723865.

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