Effectiveness of a home telemonitoring program for patients with chronic obstructive pulmonary disease in Germany: Evidence from the first three years

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) affects more than 6 million people in Germany. Monitoring the vital parameters of COPD patients remotely through telemonitoring may help doctors and patients prevent and treat acute exacerbations of COPD, improving patients’ quality of life and saving costs for the statutory health insurance system. OBJECTIVE: To evaluate the effects from October 2012 until December 2015 of a structured home telemonitoring program implemented by a statutory health insurer in Germany. METHODS: We conducted a retrospective cohort study using administrative data. After building a balanced control group using Entropy Balancing, we calculated difference-in-difference estimators to account for time-invariant heterogeneity. We estimated differences in mortality rates using Cox regression and conducted subgroup and sensitivity analyses to check the robustness of the base case results. We observed each patient in the program for up to 3 years depending on his or her time of enrolment. RESULTS: Among patients in the telemonitoring cohort, we observed significantly higher inpatient costs due to COPD (€524.2, p<0,05; €434.6, p<0.05) and outpatient costs (102.5, p<0.01; 78.8 p<0.05) during the first two years of the program. Additional cost categories were significantly increased during the first year of telemonitoring. We also observed a significantly higher number of drug prescriptions during all three years of the observation period (2.0500, p < 0.05; 0.7260, p < 0.05; 3.3170, p < 0.01) and a higher number of outpatient contacts during the first two years (0.945, p<0.01, 0.683, p<0.05). Furthermore, we found significantly improved survival rates for participants in the telemonitoring program (HR 0.68, p<0.001). CONCLUSION: On one hand, telemonitoring was associated with higher health care expenditures, especially in the first year of the program. For example, we were able to identify a statistically significant increase in inpatient costs due to COPD, outpatient contacts and drug prescriptions among individuals participating in the telemonitoring program. On the other hand, the telemonitoring program was accompanied by a survival benefit, which might be related to higher adherence rates, more intense treatment, or an improved understanding of COPD among these patients.