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A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving.

Authors
  • Bloom, Patricia P1
  • Ventoso, Martin2
  • Tapper, Elliot3
  • Ha, Jasmine4
  • Richter, James M2, 4
  • 1 Gastrointestinal Unit, University of Michigan, Taubman Center, Floor 1, Reception G, 1500 E. Medical Center Dr., Ann Arbor, MI, USA. [email protected]
  • 2 Department of Medicine, Harvard Medical School, Boston, USA.
  • 3 Gastrointestinal Unit, University of Michigan, Taubman Center, Floor 1, Reception G, 1500 E. Medical Center Dr., Ann Arbor, MI, USA.
  • 4 Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA.
Type
Published Article
Journal
Digestive Diseases and Sciences
Publisher
Springer-Verlag
Publication Date
Mar 01, 2022
Volume
67
Issue
3
Pages
854–862
Identifiers
DOI: 10.1007/s10620-021-07013-2
PMID: 34018070
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. © 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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