Heart failure telemonitoring nearly achieves cost neutrality in a high-severity cohort: a real-world net budget impact analysis
T Aguiar, M Silva, I Cruz, C Costa, S Carvalho, J Ribeiro, J M Bastos, A BriosaAbstract
Background
Telemonitoring (TM) in chronic heart failure (HF) has been associated with fewer decompensation events, yet the real-world budget impact of TM remains a key barrier to wider implementation, particularly in cohorts with high-severity admissions.
Aim
To estimate the annual net direct-cost impact of a HF TM pathway by integrating changes in healthcare utilization with local tariffs and the annual TM cost.
Methods
We performed a retrospective before–after analysis of 31 consecutive HF patients enrolled in a TM program. Healthcare utilization was assessed over the 12 months before versus after TM initiation, including hospitalizations, inpatient days, and emergency department (ED) visits. A micro-costing model applied local unit costs: hospitalization €1,074 for medium/high severity and €2,230 for high severity; ED attendance €167. The annual TM cost was €1,562 per patient. Avoided admission costs were calculated using the cohort’s admission severity distribution (10 medium/high; 21 high). The primary economic endpoint was net budget impact per patient-year, defined as TM cost minus avoided hospitalization and ED costs.
Results
Patients were predominantly male (77%), with mean age 67 years; mean LVEF was 34% and ischemic etiology was present in 81%. Weight gain was the most frequent TM alert (59%), and 67% of alerts were managed without an in-person encounter. Compared with the year before enrolment, the year after TM initiation showed reductions in hospitalizations (−0.7 ± 0.95 per patient-year; p<0.01), inpatient days (−5.8 ± 11.0; p<0.01), and ED visits (−0.3 ± 1.4). Using the observed severity mix, the weighted mean hospitalization tariff was €1,857. The estimated direct cost offset from reduced admissions and ED visits was €1,350 per patient-year. After accounting for TM cost (€1,562 per patient-year), the net budget impact was +€212 per patient-year, equivalent to +€6,570 annually for the 31-patient cohort; TM therefore offset approximately 86% of its annual per-patient cost under these assumptions.
Conclusions
In a real-world HF cohort with predominantly medium/high-to-high severity admissions, TM was associated with lower acute-care utilization and substantial direct cost offsets, approaching cost neutrality at a program cost of €1,562 per patient-year. These findings support prioritizing TM for higher-risk, high-cost HF populations and justify prospective evaluation including full operational costing and broader healthcare resource capture.