Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery

• Published in: Medical care Vol. 59; no. 11; pp. 1023 - 1030
• Main Authors: Bhardwaj, Vinayak, Spaulding, Erin M., Marvel, Francoise A., LaFave, Sarah, Yu, Jeffrey, Mota, Daniel, Lorigiano, Ting-Jia, Huynh, Pauline P., Shan, Rongzi, Yesantharao, Pooja S., Lee, Matthias A., Yang, William E., Demo, Ryan, Ding, Jie, Wang, Jane, Xun, Helen, Shah, Lochan, Weng, Daniel, Wongvibulsin, Shannon, Carter, Jocelyn, Sheidy, Julie, McLin, Renee, Flowers, Jennifer, Majmudar, Maulik, Elgin, Eric, Vilarino, Valerie, Lumelsky, David, Leung, Curtis, Allen, Jerilyn K., Martin, Seth S., Padula, William V.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-11-2021; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Acute Disease; Blood pressure; Cardiovascular diseases; Cost analysis; Cost control; Cost reduction; Cost-Benefit Analysis; Costs; Currencies; Health care; Health promotion; Health risks; Heart attacks; Humans; Markov Chains; Myocardial infarction; Myocardial Infarction - rehabilitation; Patients; Probabilistic analysis; Quality-Adjusted Life Years; Risk management; Risk reduction; Sensitivity analysis; Smartphones; Smartwatches; Telemedicine - economics
• ISSN: 0025-7079; 1537-1948; 1537-1948
• DOI: 10.1097/MLR.0000000000001636

Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone.
A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty.
The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone.
Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.