Abstract 12698: Alert-Driven versus Scheduled Remote Monitoring of Implantable Cardiac Defibrillators: An Economic Analysis From the Trust Randomized Trial

Introduction: Current implementation of remote patient monitoring (RPM) for implantable cardioverter defibrillators (ICDs) involves a hybrid of remote assessment and in-person evaluation (IPE) every 3 months. Alert-driven RPM or fully virtual care without routine visits may reduce non-actionable patient evaluation, increased clinic workload and inefficient resource allocation. Objective: To conduct a cost-consequence analysis to compare three patient management strategies following ICD implantation: (a) IPE only, (b) RPM-conventional (hybrid of IPE and RPM), and (c) RPM-alert (alert-based ICD follow up). Methods: We constructed a decision-analytic Markov model to estimate the costs and benefits of three strategies of patient management following ICD implantation over a two-year time horizon from the perspective of the US healthcare system. Aggregate and patient-level data from the TRUST (Lumos-T Safely RedUceS RouTine Office Device Follow-up) clinical trial informed clinical effectiveness model inputs. TRUST randomized 1339 patients 2:1 to conventional RPM or IPE alone, and found that RPM was safe and reduced the number of non-actionable encounters. Cost data was obtained from the published literature. The primary outcome was incremental cost. Results: The mean cumulative costs per patient were $12,688 in the IPE group, $12,001 in the RPM-conventional group, and $11,011 in the RPM-alert group. Compared to the IPE group, both the RPM-conventional and RPM-alert groups were associated with lower incremental costs of -$687 (95% confidence interval (CI)-$2,138 to +$638) and -$1,677 (95% CI -$3,134 to -$304), respectively. Of the three groups, the RPM-alert strategy was the most cost-effective strategy with an estimated cost-savings in 99% of simulations. Conclusions: Alert-driven RPM was economically attractive and, if patient outcomes and safety are comparable to conventional RPM, may be the preferred strategy of patient follow up.