Telemonitoring Just as Beneficial as In-Person Monitoring for Patients With RA Initiating DMARDs

The use of telemedicine to monitor patients with rheumatoid arthritis (RA) initiating disease-modifying anti-rheumatic drug (DMARD) therapy was highly cost-effective and resulted in similar health outcomes compared with in-person monitoring, according to a study published in Joint Bone Spine.

More specifically, the authors found that telemonitoring:

• Reduced in-person visits
• Was related to improved patient health status
• Was less expensive than in-person monitoring
• Was cost-effective for patients starting DMARD treatment

RA is a financial burden for patients with the disease, costing Americans hundreds to up to tens of thousands of dollars annually in both direct and indirect costs. According to the European League Against Rheumatism (EULAR), individual, social, and medical costs should be considered when deciding to initiate a new treatment, and treatment strategies such as treat-to-target take these factors into account.

“Indeed, in industrialized countries there is an incongruity between recommendations for care and the capacity of the health system to meet these guidelines stemming from a general lack of patient access to rheumatologists and an irregular distribution of medical services, particularly in rural areas,” the authors wrote. “Consequently, alternatives to conventional prescheduled outpatient follow-ups, such as telemedicine, could potentially support RA self-management and strengthen the implementation of the EULAR recommendations.”

To evaluate the cost-effectiveness and medico-economic results of telemonitoring compared with conventional in-person monitoring, researchers conducted an economic evaluation alongside a two-arm randomized clinical trial in France.

Of 89 patients with RA aged between 18 and 75 years and with an indication to start DMARD therapy, 45 received telemonitoring and 44 received conventional monitoring. Baseline characteristics were similar between groups.

In the telemonitoring group, patients experienced significantly lower costs for hospital visits, on average (€69.4 [$76.2] vs €99.7 [$109.5], P < .01), as well as lower transportation (€336.5 [$369.6] vs €435.5 [$478.4]) and inpatient admissions costs (€1606.8 [$1764.9] vs €2464.6 [$2707.2).

While the €914.9 ($1004.9) cost of the SATIE PR smartphone application brought up costs for this group, overall costs were still lower for the telemonitoring group compared with the conventional monitoring group (€2927.7 [$3215.9] vs €2999.7 [$3294.9], P <.01).

Health outcomes were assessed using the EuroQol-5D (EQ-5D) questionnaire and quantified by the gain in quality-adjusted life years (QALYs). Mean EQ-5D scores increased in both groups, with a very slight further increase in the telemonitoring group, suggesting that health status improvement was not influenced by the type of monitoring.

Additionally, QALYs were not significantly different between the telemonitoring (QALY = 0.56) and conventional monitoring (0.63) groups.

These findings suggest that telemonitoring and other telehealth interventions are cost-effective while resulting in similar health outcomes to in-person monitoring. However, the authors emphasized that more research in this area is needed, especially noting the short follow-up period and small sample size.

“The explosion of telemedicine also brings new challenges for the organization of care and requires that rheumatologists learn how to use the technology to maximize patient benefit,” the authors said. “The growth of telemedicine will also necessitate a major change in the doctor-patient relationship since an additional partner (a nurse, a professional trained in monitoring chronic diseases, etc.) will need to establish a new confidence-based relationship.”

Reference

Bernard L, Valsecchi V, Mura T, et al. Management of patients with rheumatoid arthritis by telemedicine: the cost-effectiveness of connected monitoring. A randomized controlled trial [published online March 4, 2022]. Joint Bone Spine. doi:10.1016/j.jbspin.2022.105368