Cost-effectiveness of remote monitoring for cardiac implantable electronic devices compared with conventional follow-up: a systematic review

Abstract Background Remote monitoring (RM) of cardiovascular implantable electronic devices (CIEDs) is a form of virtual patient care that involves electronic transmission of CIED diagnostics and remote assessment of this information by clinic staff. Despite expert recommendations advocating its use, adoption remains modest due to inconsistent funding policies across health systems. Purpose This study aims to identify and synthesize existing literature in the cost-effectiveness of RM compared with in-person clinic assessments alone in patients with CIEDs. Methods We conducted a systematic review of available economic evaluations (including cost-effectiveness, cost-utility, cost-consequence analyses) and costing analyses (which examines costs but not clinical benefits) of RM following CIED implantation compared to in-person clinic follow-up alone. Study outcomes included incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Results Of the 1151 unique citations, a total of 27 studies were included. The studies were from Europe (n=20), USA (n=5), or Canada (n=2). Remote transmissions, when detailed in the study, were predominantly patient- and/or physician- triggered, but some also included automatic home monitor transmissions. Fourteen studies (52%) were costing analyses, and the remaining 13 studies were economic evaluations. The majority of studies (78%; n=21) reported cost-savings associated with RM compared to in-clinic follow up alone. Of the 13 economic evaluations, there were 6 cost-utility analyses, which all reported that RM provided additional QALYs for additional costs that met country-specific thresholds for good value in health care. Studies varied greatly in the costs considered, the outcomes measured, and the time horizons used. Conclusion Remote monitoring of patients with CIEDs was associated with cost-savings in most studies and across different healthcare systems. RM may be considered cost-effective when conventional thresholds for good value in health care are adopted. Despite heterogeneity in methods of economic evaluation in the studies included, the overall data in this systematic review supports greater implementation of RM technology to improve health system costs and efficiency.