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The role of the economic evaluation in the RENEWING HEALTH Project.
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The role of the economic evaluation in the
RENEWING HEALTH Project
Bilbao, 27th June 2012
Silvia Mancin Arsenàl.IT
Veneto’s Research Centre for eHealth innovation
Background
The overall background of the project is a number of EU conferences and reports describing
telemonitoring and the potential benefits of a wider use of telemedicine applications in Europe.
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Why telemonitoring is not widely diffused in health systems?
Possible reasons
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Evidences of contribution to quality of care
Technology
Organizative models
Physician/patients perspective
Legal aspects
Cost/effectiveness
Monies
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RENEWING HEALTH:REgioNs of Europe WorkINg toGether for
HEALTH
• Programme: RENEWING HEALTH is the second Pilot Type A eHealth project funded under the Competitiveness and Innovation Framework Programme CIP ICT PSP (Information and Communications Technologies – Policy Support Programme)
• Project start date: 1st February 2010
• Total budget: 14.000.000 Euros
• EU contribution: 7.000.000 Euros
• European Regions involved: 9
• Patients involved: about 8000
AIM of RENEWING HEALTH
Validating, in real life settings and with a
common rigorous assessment methodology
(MAST), the use of existing Personal Health
Systems for innovative types of Telemedicine
services used to monitor chronic patients
with
Cardiovascular Disease (CVD),
Chronic Obstructive Pulmonary Disease (COPD)
Diabetes
and prepare for their wider
deployment.
Assessment Methodology: MAST
MAST – Model for ASsessment of Telemedicine
New model for assessing the effectiveness and contribution to quality of care of telemedicine
applications
A multi-disciplinary process that summarizes and evaluates information about the medical,
social, economic and ethical issues related to the use of telemedicine in a systematic, unbiased
and robust manner
Cluster 4 COPDShort-term follow-up after hospital discharge
Cluster 3 DiabetesUlcer monitoring
Telemonitoring services
Cluster 1 DiabetesMedium-term health coaching and life-long monitoring
Cluster 2 DiabetesLife-long monitoring
Cluster 5 COPDLife-long monitoring
Cluster 6 CVDMedium-term health coaching and life-long monitoring
Cluster 7 CVDRemote monitoring of Congestive Heart Failure
Cluster 8 CVDRemote monitoring of implantable cardiac devices
Cluster 10 Multi pathologyMonitoring of frail patients with chronic deseases
Elegibility Criteria and Sample Size – Cluster 5
COPD Diagnosis of COPD, GOLD Class III-IV Life expectance > 12 months Patient able to use the equipment provided (alone or
assisted).
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Elegibility Criteria and Sample Size – HF Cluster
7 Age 65 years Discharge from hospital after acute HF in the previous 3 months and EF < 40% or EF >
40% plus BNP > 400 (or plus NT-proBNP>1500) during hospitalisation No comorbidities prevalent on CHF with life expectation < 12 months No myocardial infarction or percutaneous coronary intervention in last 3 months, or
scheduled No coronary artery bypass, valve substitution or correction in last 6 months Patient able to use the equipment provided (alone or assisted) Being on waiting list for heart transplantation Being enrolled in other trial
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10
10
Regional eHealth Centre
Patient’s home
Gateway
Patient
Telemonitoring devices
2
3
4Intervention service
General Practitioner
6
1
Alarm device
5
Regional Centre’s Operator
Family/CaregiverData transmission
Data access through Home Care portal
Alarm management
Contact with the patient
7
Social worker
Veneto Region serviceSpecialist
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Assessment Methodology: MAST- Model for ASsessment of Telemedicine
Rigorous assessment of
TELEMONITORINGSERVICES
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Outcomes
CLUSTER 5 - COPD
Outcomes
CLUSTER 7 – Heart Failure
Enrollment start: October 2011
Enrollment period: 6 months 12 months
Follow up period: 12 months
Final Results: December 2013
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Project timeline
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Veneto Region COPD Consort
Assessed for elegibility (n=369)
Randomised (n=277)
Excluded (n=92)Not meeting inclusion criteria (n=67)Decline to participate (n=19)Other reasons (n=6)
Allocated to intervention (n=198)Received allocated intervention (n=152)Did not received intervention (n=8)Waiting to receive intervention (n=37)
Allocated to usual care (n=79)
Lost to follow-up (n=3)Discontinued intervention (n=0)
Lost to follow-up (n=5)Discontinued intervention (n=0)
Analysed (n=0)Excluded from analysis (n=0)
Analysed (n=0)Excluded from analysis (n=0)
* 93% of Sample Size updated to 21 May 2012
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Veneto Region HFConsort
Assessed for elegibility (n=163)
Randomised (n=134*)
Excluded (n=29)Not meeting inclusion criteria (n=24)Decline to participate (n=5)Other reasons (n=0)
Allocated to intervention (n=89)Received allocated intervention (n=61)Did not received intervention (n=8)Waiting for receiving intervention (n=20)
Allocated to usual care (n=45)
Lost to follow-up (n=2)Discontinued intervention (n=0)
Lost to follow-up (n=8)Discontinued intervention (n=0)
Analysed (n=0)Excluded from analysis (n=0)
Analysed (n=0)Excluded from analysis (n=0)
*43% of Sample Size update to 21 May 2012
Who is the patient?
Socio-Demographics level
Preliminary Results at baseline
Veneto Preliminary Outcomes:Socio-demographic at baseline
Cluster 5 COPD Life-long monitoring
Veneto Preliminary Outcomes:Socio-demographic at baseline
Cluster 7 Remote monitoring of CHF
Skills with technology
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Are you familiar with using a personal computer (PC)?
Are you familiar with using a mobile phone?
Who is the patient?
Geographical spread
Patients – Cluster 5
Patients’ distance from healthcare structureAverage distance (one way): 9,5 kmAverage travelling time (one way): 15,4 minutes
Patients – Cluster 7
Patients’ distance from healthcare structureAverage distance (one way): 10,1 kmAverage travelling time (one way): 17,5 minutes
Transport used to go to the healthcare structure
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25
Assessment Methodology: MAST- Model for ASsessment of Telemedicine
Rigorous assessment of
TELEMONITORINGSERVICES
HE
ALT
H T
EC
HN
OLO
GY
A
SS
ES
SM
EN
T
HE
ALT
H T
EC
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OLO
GY
A
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Economic analysis
Perspective
• Broad: takes into account all kinds of resources and benefits
• Aim: assessing the service’s overall cost-effectiveness
• Narrower: adopts the LHA’s point of view
• Aim: assessing the company’s financial return when providing the service
• ICER (Incremental Cost-effectveness ratio)– based on SF-6D’s QALYs
• Cost per clinical event avoided (CEA)
Societal
• Return on Investments (ROI)
• Total cost of intervention• Break even analysis• DRG-rate
Business Case
Outcomes
Describe resources, data collection and level of estimation
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Cost analysis and reporting
Veneto Preliminary Outcomes:Costs at baseline
Cluster 5 COPDLife-long monitoring
Veneto Preliminary Outcomes:Costs at baseline
Cluster 7 CVDRemote monitoring of
CHF
*Rapporto Statistico 2011, Veneto Region
Veneto:demographics
In the Veneto Region*:
• 20% of population is over 65
• 16.5% of the elderly population is at risk of poverty
• 68% of people over 75 years is suffering from at least two chronic degenarative diseases
• 46% prelevance of multiple chronic diseases in the population aged between 65 and 74
• Patients affected by COPD 238.000
• Patients affected by CHF 70.000
Expected Results
Carring out a detailed and rigorous report to be used as a basis for decision
Validating a New model for the assessment of telemedicine services (Health Technology Assessment)
Guidelines for the European Countries on how the european prototypes of telemonitoring services can become Large Scale Pilots.
FROM PILOT TO MARKET
