Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients
This was an economic analysis of a 12-month, parallel arm, randomized controlled trial in adult kidney recipients 6 to 36 months posttransplant (NCT03247322). All participants received usual posttransplant care, while the intervention arm received supplemental clinical pharmacist-led medication therapy monitoring and management, via a smartphone-enabled mHealth app, integrated with risk-based televisits. Hospitalization charges were captured from the study institution accounts payable and non-study institution hospitalization charges were estimated using multiple imputation. Multivariable modeling was used to assess the impact of the intervention on charges. The intervention significantly reduced rates of hospitalization (1.08 per patient-year in the control arm vs 0.65 per patient-year in the intervention arm, p = .007). The control arm had estimated hospitalization costs of $870,468 vs $390,489 in the intervention arm. Modeling demonstrated a 49% lower hospitalization charge risk in the intervention arm (RR 0.51, 95% CI 0.28-0.91; p = .022). From a payer or societal perspective, the net estimated cost savings, after accounting for intervention delivery costs, was $368,839, with a return on investment (ROI) of $4.30 for every $1 spent. These results demonstrate that a mHealth-enabled, pharmacist-led intervention significantly reduced hospitalization costs for payers over a 12-month period and has a positive ROI.
CET Conclusion
| Reviewer: | Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | This is a health-economic analysis from the payer perspective of a previously published pharmacist-led, mobile health (mHealth) intervention to facilitate the management of patients using remote monitoring and telehealth. The a priori planned analysis evaluated all costs associated with hospitalisation during the 12-month follow up. The mHealth intervention had previously shown to reduce the hospitalisation rate, medication errors and drug adverse events. Cost data were estimated using validated methods. The hospitalisation costs were significantly lower in the intervention versus the control arm ($390,489 versus $870,468) with a significant return on investment ($4.30 for every $1 spent). The authors suggest that cost-savings should be passed on to the transplant centres so that they can recover the costs of implementing the intervention. |
Methodological quality
| Jadad score | 3 |
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| Allocation concealment | YES |
| Data analysis | PER PROTOCOL |
Study Details
| Aims: | This economic analysis of a previously published randomised controlled trial aimed to evaluate the impact of a pharmacist-led, mobile health (mHealth) intervention on healthcare costs. |
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| Interventions: | Participants in the original trial were randomised to either the mHealth-based intervention group or the usual care group. |
| Participants: | 136 kidney transplant recipients. |
| Outcomes: | The main outcome of interest was an a priori planned economic assessment of the mHealth intervention. |
| Follow Up: | 12 months |
Metadata
| Funding: | Non-industry funding |
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| Publication type: | Randomized Controlled Trial, Randomised Controlled Trial |
| Trial registration: | ClinicalTrials.gov - NCT03247322 |
| Organ: | Kidney |
| Language: | English |
| Author email: | taberd@musc.edu |
| MeSH terms: | Adult; Cost Savings; Hospitalization; Humans; Kidney Transplantation; Pharmacists; Telemedicine; Clinical Research; Drug Toxicity; Economics; Hospital Readmission |