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Randomized Controlled Trial
. 2024 Oct 9;21(10):e1004459.
doi: 10.1371/journal.pmed.1004459. eCollection 2024 Oct.

Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: A randomised controlled trial

Lukas Schöner  1 , David Kuklinski  2 , Laura Wittich  1 , Viktoria Steinbeck  1 , Benedikt Langenberger  1 , Thorben Breitkreuz  3 , Felix Compes  4 , Mathias Kretzler  5 , Ursula Marschall  6 , Wolfgang Klauser  7 , Mustafa Citak  8 , Georg Matziolis  9 , Daniel Schrednitzki  10 , Kim Grasböck  11 , Justus Vogel  2 , Christoph Pross  1 , Reinhard Busse  1 , Alexander Geissler  2
Affiliations
Randomized Controlled Trial

Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: A randomised controlled trial

Lukas Schöner et al. PLoS Med. .

Abstract

Background: While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement.

Methods and findings: The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals. The analysis was conducted with a subset of 546 hip and 492 knee replacement cases with longitudinal cost data from 24 statutory health insurances. Patients were randomised 1:1 to a PROM-based remote monitoring and alert intervention or to a standard care group. All patients were assessed at 12-months post-surgery via digitally collected PROMs. Patients within the intervention group were additionally assessed at 1-, 3-, and 6-months post-surgery to be contacted in case of critical recovery paths. For the effect evaluation, a PROM-based composite measure (PRO-CM) was developed, combining changes across various PROMs in a single index ranging from 0 to 100. The PRO-CM included 6 PROMs focused on quality of life and various aspects of physical and mental health. The primary outcome was the incremental cost-effectiveness ratio (ICER). The intervention group showed incremental outcomes of 2.54 units PRO-CM (95% confidence interval (CI) [0.93, 4.14]; p = 0.002) for patients with hip and 0.87 (95% CI [-0.94, 2.67]; p = 0.347) for patients with knee replacement. Within the 12-months post-surgery period the intervention group had less costs of 376.43€ (95% CI [-639.74, -113.12]; p = 0.005) in patients with hip, and 375.50€ (95% CI [-767.40, 16.39]; p = 0.060) in patients with knee replacement, revealing a dominant ICER for both procedures. However, it remains unclear which step of the multistage intervention contributes most to the positive effect.

Conclusions: The intervention significantly improved patient outcomes at lower costs in patients with hip replacements when compared with standard care. Further it showed a nonsignificant cost reduction in knee replacement patients. This reinforces the notion that PROMs can be utilised as a cost-effective instrument for remote monitoring in standard care settings.

Trial registration: Registration: German Register for Clinical Studies (DRKS) under DRKS00019916.

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Conflict of interest statement

The project was funded by the Innovation Fund of the of Joint Federal Committee Germany (01NVF18016). Project funding was paid to the consortium institutions and covered the employment positions of LS, VS, LW, BL and CP. CP reports a salaried position with MedTech company Stryker that is separate and independent from his university research employment and position. FC reports an employment relation with Heartbeat Medical Solutions GmBH. GM reports receiving royalties or contracts, grants, consulting fees, payments for lectures and leadership in other boards, all outside the submitted work. RB reports being member of the government commission on modern and needs-based hospital care, outside the submitted work. DS reports receiving payments for lectures from Zimmer Biomet outside the submitted work. All other authors declare no competing interests.

Figures

Fig 1
Fig 1. Trial profile.
PROMs, patient-reported outcome measures.
Fig 2
Fig 2. Mixed effect model estimates for the intervention group.
Fig 2 displays the mixed effect model point estimates of the intervention effect on PRO-CM and post-surgery costs (solid lines) as well as on secondary outcomes (dashed lines). The lines represent their corresponding 95% CIs. The numbers in brackets indicate the corresponding p-values. Outcomes and costs were standardised to z-scores to enable comparability. Point estimates above zero indicate better health outcomes or higher costs in the intervention group (in SDs); point estimates below zero indicate worse health outcomes or lower costs in the intervention group compared to the control group. In patients with hip replacement HOOS-PS was used, in patients with knee replacement KOOS-PS was used. PRO-CM, patient-reported outcome composite measure; EQ-5D-5L, EuroQol 5 dimensions, 5 levels; EQ-VAS, EuroQol virtual analogue scale; HOOS-PS, Hip Disability and Osteoarthritis Outcome Score Physical Function Short-form; KOOS-PS, Knee Injury and Osteoarthritis Outcome Score Physical Function Short-form; PROMIS, Patient-Reported Outcomes Measurement Information System Depression Shortform (PROMIS-D-SF) and Fatigue Shortform (PROMIS-F-SF).
Fig 3
Fig 3. Cost-effectiveness of the PROM intervention in patients with hip and patients with knee replacement.
See this image and copyright information in PMC

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