Blood pressure telemonitoring: an economic analysis of the vigisante project
Résumé
Aim: to implement a cost-effectiveness analysis of the telemedicine project VigiSante. VigiSante is a project combining screening for hypertension in firm, supporting by a medicalized platform, in connection with general practitioner (GP) and telemonitoring of hypertensive patients at home on the Nord-Pas-de-Calais region (North of France) population. According to Wagner et al. (2008), the hypertension prevalence is 34.8% at the threshold of 140/90 mm Hg in the age group of 35-64 years old in France. Hypertension is the leading chronic disease in the world. It increases the risk of accidents stroke, coronary heart disease, heart failure, kidney failure and cognitive impairment. Antihypertensive treatment aims at reducing cardiovascular complications. In France, the number of patients treated for hypertension is estimated around twelve million (according to the French National Authority for Health). Methods: The assessment is based on the comparison of two groups: an interventional group which is the VigiSanté group (669 patients) and a control group (retrospective data of 145 patients), which is divided into two parts, medical data and health expenses respectively. Medical data were collected by a physician from medical records. For the economic data, the National Health Insurance Fund database was used to collect the medical consumption of a sample of hypertensive patients in the North of France and the retrospective consumption data of the VigiSanté patients. For the cost-effectiveness study, an Incremental Cost-Effectiveness Ratio (ICER) is caluculated. To measure the effectiveness, we use the survival data analysis method. All data were collected, the cost-effectiveness assessment is being analyzed. Results: the implementation of service such as VigiSanté met expectations of patients and health professionals. From the patient's point of view, medical information present in e-health programs can improve the diagnosis and treatment. 59% of patients involved in the project experienced an improvement in their health, 80% were satisfied with the follow-up of their hypertension monitoring and support, and even more than 80% of attendees would recommend it to relatives. From the physicians' point of view, the implementation of such a service strengthens the role of General Practitioner. The study shows that for about 69% of General Practitioners, the integration of patients in VigiSanté allowed global health benefits included on blood pressure. Conclusion: at a time when prevention policies appear to be the cornerstone of an efficient health care system, Vigisanté is an alternative and relevant health risk identification mode, allowing to trigger and accelerate the diagnosis and / or supported by the attending physician in hypertensive patients.