The role of the economic evaluation in the RENEWING HEALTH Project.

1. The role of the economic
evaluation in the RENEWING
HEALTH Project
Silvia Mancin
Arsenàl.IT
Veneto’s Research Centre for eHealth innovation
Bilbao, 27th June 2012

2. Background
The overall background of the project is a number of
EU conferences and reports describing
telemonitoring and the potential benefits of a wider
use of telemedicine applications in Europe.
Why telemonitoring is not widely diffused in health
systems?
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3. Possible reasons
 Evidences of contribution to quality of care
 Technology
 Organizative models
 Physician/patients perspective
 Legal aspects
 Cost/effectiveness
X
 Monies
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4. RENEWING HEALTH:
REgioNs of Europe WorkINg toGether for HEALTH
• Programme: RENEWING HEALTH is the second Pilot Type
A eHealth project funded under the Competitiveness
and Innovation Framework Programme CIP ICT PSP
(Information and Communications Technologies –
Policy Support Programme)
• Project start date: 1st February 2010
• Total budget: 14.000.000 Euros
• EU contribution: 7.000.000 Euros
• European Regions involved: 9
• Patients involved: about 8000

5. AIM of RENEWING HEALTH
Validating, in real life settings and with a common
rigorous assessment methodology (MAST), the use
of existing Personal Health Systems for innovative
types of Telemedicine services used to monitor
chronic patients with
Cardiovascular Disease (CVD),
Chronic Obstructive Pulmonary Disease (COPD)
Diabetes
and prepare for their wider deployment.

6. Assessment Methodology:
MAST
MAST – Model for ASsessment of Telemedicine
New model for assessing the effectiveness and
contribution to quality of care of telemedicine
applications
A multi-disciplinary process that summarizes and
evaluates information about the medical, social,
economic and ethical issues related to the use of
telemedicine in a systematic, unbiased and robust
manner

7. Telemonitoring services
Cluster 1 Diabetes Cluster 6 CVD
Medium-term health Medium-term health
coaching and life-long coaching and life-long
monitoring monitoring
Cluster 2 Diabetes Cluster 7 CVD
Life-long monitoring Remote monitoring of
Congestive Heart
Failure
Cluster 3 Diabetes
Ulcer monitoring Cluster 8 CVD
Remote monitoring of
implantable cardiac
Cluster 4 COPD devices
Short-term follow-up after
hospital discharge
Cluster 10 Multi
pathology
Cluster 5 COPD Monitoring of frail
Life-long patients with chronic
monitoring deseases

8. Elegibility Criteria and Sample
Size – Cluster 5 COPD
 Diagnosis of COPD, GOLD Class III-IV
 Life expectance > 12 months
 Patient able to use the equipment provided (alone or
assisted).
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9. Elegibility Criteria and
Sample Size – HF Cluster 7
 Age ≥ 65 years
 Discharge from hospital after acute HF in the previous 3 months and EF < 40%
or EF > 40% plus BNP > 400 (or plus NT-proBNP>1500) during hospitalisation
 No comorbidities prevalent on CHF with life expectation < 12 months
 No myocardial infarction or percutaneous coronary intervention in last 3
months, or scheduled
 No coronary artery bypass, valve substitution or correction in last 6 months
 Patient able to use the equipment provided (alone or assisted)
 Being on waiting list for heart transplantation
 Being enrolled in other trial
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10. Veneto Region service
Specialist
Patient’s home Regional eHealth
Centre
Telemonitoring
devices
Gateway
2
3 7 General Practitioner
1
4
Patient Intervention service
6
5
Alarm device Regional Centre’s
Operator Social worker
Family/Caregiver
Data transmission
Data access through Home Care portal
10
10 Alarm management
Contact with the patient

11. Assessment Methodology: MAST- Model for
ASsessment of Telemedicine
HEALTH TECHNOLOGY
HEALTH TECHNOLOGY
ASSESSMENT
ASSESSMENT
Rigorous assessment
of
TELEMONITORING
SERVICES
11

12. Outcomes
CLUSTER 5 - COPD

13. Outcomes
CLUSTER 7 – Heart Failure

14. Project timeline
 Enrollment start: October 2011
 Enrollment period: 6 months  12 months
 Follow up period: 12 months
 Final Results: December 2013
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15. Veneto Region COPD
Consort
Assessed for elegibility (n=369)
Excluded (n=92)
Not meeting inclusion criteria (n=67)
Decline to participate (n=19)
Other reasons (n=6)
Randomised (n=277)
Allocated to intervention (n=198) Allocated to usual care (n=79)
Received allocated intervention (n=152)
Did not received intervention (n=8)
Waiting to receive intervention (n=37)
Lost to follow-up (n=3) Lost to follow-up (n=5)
Discontinued intervention (n=0) Discontinued intervention (n=0)
Analysed (n=0) Analysed (n=0)
Excluded from analysis (n=0) Excluded from analysis (n=0)
15
* 93% of Sample Size updated to 21 May 2012

16. Veneto Region HF
Consort
Assessed for elegibility (n=163)
Excluded (n=29)
Not meeting inclusion criteria (n=24)
Decline to participate (n=5)
Other reasons (n=0)
Randomised (n=134*)
Allocated to intervention (n=89) Allocated to usual care (n=45)
Received allocated intervention (n=61)
Did not received intervention (n=8)
Waiting for receiving intervention (n=20)
Lost to follow-up (n=2) Lost to follow-up (n=8)
Discontinued intervention (n=0) Discontinued intervention (n=0)
Analysed (n=0) Analysed (n=0)
Excluded from analysis (n=0) Excluded from analysis (n=0)
16
*43% of Sample Size update to 21 May 2012

17. Preliminary Results at
baseline
Who is the patient?
Socio-Demographics level

18. Veneto Preliminary Outcomes:
Socio-demographic at baseline
Cluster 5 COPD Life-long monitoring

19. Veneto Preliminary Outcomes:
Socio-demographic at baseline
Cluster 7 Remote monitoring of CHF

20. Skills with technology
Are you familiar with using a personal Are you familiar with using a mobile
computer (PC)? phone?
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21. Who is the patient?
Geographical spread

22. Patients – Cluster 5
Patients’ distance from healthcare structure
Average distance (one way): 9,5 km
Average travelling time (one way): 15,4 minutes

23. Patients – Cluster 7
Patients’ distance from healthcare structure
Average distance (one way): 10,1 km
Average travelling time (one way): 17,5 minutes

24. Transport used to go to the
healthcare structure
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25. Assessment Methodology: MAST- Model for
ASsessment of Telemedicine
HEALTH TECHNOLOGY
HEALTH TECHNOLOGY
ASSESSMENT
ASSESSMENT
Rigorous assessment
of
TELEMONITORING
SERVICES
25

26. Economic analysis
Societal Business Case
Perspective
• Broad: takes into account • Narrower: adopts the LHA’s
all kinds of resources and point of view
benefits
• Aim: assessing the service’s • Aim: assessing the
overall cost-effectiveness company’s financial return
when providing the service
Outcomes
• ICER (Incremental Cost- • Return on Investments (ROI)
effectveness ratio)– based • Total cost of intervention
on SF-6D’s QALYs • Break even analysis
• Cost per clinical event • DRG-rate
avoided (CEA)

27. Cost analysis and reporting
Describe resources, data collection and level of estimation
27

28. Veneto Preliminary Outcomes:
Costs at baseline
Cluster 5 COPD
Life-long monitoring

29. Veneto Preliminary Outcomes:
Costs at baseline
Cluster 7 CVD
Remote monitoring of CHF

30. Veneto:
demographics
In the Veneto Region*:
• 20% of population is over 65
• 16.5% of the elderly population is at risk of poverty
• 68% of people over 75 years is suffering from at least
two chronic degenarative diseases
• 46% prelevance of multiple chronic diseases in the
population aged between 65 and 74
• Patients affected by COPD 238.000
• Patients affected by CHF 70.000
Rapporto Statistico 2011, Veneto Region
*

31. Expected Results
 Carring out a detailed and rigorous
report to be used as a basis for decision
 Validating a New model for the
assessment of telemedicine services
(Health Technology Assessment)
 Guidelines for the European Countries
on how the european prototypes of
telemonitoring services can become
Large Scale Pilots.
FROM PILOT TO MARKET

32. Thank you for your attention
Silvia Mancin
smancin@consorzioarsenal.it
www.renewinghealth.eu