期刊
DIGESTIVE DISEASES AND SCIENCES
卷 67, 期 3, 页码 854-862出版社
SPRINGER
DOI: 10.1007/s10620-021-07013-2
关键词
Healthcare delivery; Ascites; Telemedicine; Cost-effectiveness; Technology
资金
- AASLD Advanced Transplant Hepatology Award
- ACG Junior Faculty Award
- National Institutes of Health [K23DK117055, KL2TR002241]
Telemonitoring intervention is cost-saving and effective for managing cirrhotic ascites, leading to improved patient outcomes through proactive medical intervention and increased large volume paracenteses.
Background Patients with cirrhosis and ascites experience frequent hospital admissions, leading to poor quality of life and high healthcare costs. Monitoring weight is a component of ascites care and telemonitoring may improve outcomes and costs. Goals We aimed to evaluate the cost and outcomes of current care compared to a telemonitoring system for ascites. Study We developed a decision-analytic model that examined 100 simulated patients over a 6-month horizon. We compared usual care to a new telemonitoring program, which we estimate costs $50,000/6 months. Results The cost of standard of care for 100 patients with cirrhotic ascites over a 6-month period is $167,500 more expensive than telemonitoring. By varying parameter probabilities by +/- 10% and outcome costs by +/- 20%, we found that standard of care remains more expensive than care with a telemonitoring intervention by $9400 to $340,200 per 6-month period. Standard of care leads to 9 more admissions (range 4 to 12) than a telemonitoring intervention, while telemonitoring leads to 9 more outpatient visits (range 6 to 9) and 28 additional outpatient large volume paracenteses (LVPs) (range 17 to 28). With more and less expensive telemonitoring interventions, standard of care remained more expensive. With 50% adherence to the intervention, standard of care was $89,848 more expensive. Conclusions In almost all probability and cost scenarios, a telemonitoring intervention is cost-saving for the management of cirrhotic ascites. Using hospital admissions as a surrogate for quality of care, patient outcomes are improved primarily though more proactive medical intervention and more LVPs.
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