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A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving

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...

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Autores principales: Bloom, Patricia P., Ventoso, Martin, Tapper, Elliot, Ha, Jasmine, Richter, James M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136259/
https://www.ncbi.nlm.nih.gov/pubmed/34018070
http://dx.doi.org/10.1007/s10620-021-07013-2
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author Bloom, Patricia P.
Ventoso, Martin
Tapper, Elliot
Ha, Jasmine
Richter, James M.
author_facet Bloom, Patricia P.
Ventoso, Martin
Tapper, Elliot
Ha, Jasmine
Richter, James M.
author_sort Bloom, Patricia P.
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10620-021-07013-2.
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spelling pubmed-81362592021-05-21 A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving Bloom, Patricia P. Ventoso, Martin Tapper, Elliot Ha, Jasmine Richter, James M. Dig Dis Sci Original Article 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10620-021-07013-2. Springer US 2021-05-06 2022 /pmc/articles/PMC8136259/ /pubmed/34018070 http://dx.doi.org/10.1007/s10620-021-07013-2 Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Bloom, Patricia P.
Ventoso, Martin
Tapper, Elliot
Ha, Jasmine
Richter, James M.
A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving
title A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving
title_full A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving
title_fullStr A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving
title_full_unstemmed A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving
title_short A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving
title_sort telemonitoring intervention for cirrhotic ascites management is cost-saving
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136259/
https://www.ncbi.nlm.nih.gov/pubmed/34018070
http://dx.doi.org/10.1007/s10620-021-07013-2
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