The costs of home monitoring by telemedicine versus standard care for inflammatory bowel diseases - a Danish register-based, five-year follow-up study.

Abstract

Background and aims: There are few studies on the cost-effectiveness of telemedicine for inflammatory bowel diseases (IBD). We assessed the long-term cost-effectiveness of a telemedicine solution (eCare) compared to standard care (sCare), as well as its efficacy according to patient-reported outcomes (PRO).

Methods: Between 2015 and 2020 we conducted a retrospective, register-based study among patients with ulcerative colitis (UC) and Crohn's disease (CD). Direct and indirect healthcare costs over a five-year period were obtained from Danish registers and compared to a control group. Costs were estimated on a yearly basis from one year before, until five years after, inclusion in the trial. Patients were divided into cohorts of those not receiving (cohort 1), and those receiving (cohort 2), biologics.

Results: We recruited 574 IBD patients. In cohort 1 (61.5%), average total direct costs and total earnings per patient per year were €14,043 and €307,793 in eCare compared to €16,226 and €252,166 in sCare, respectively. In cohort 2 (38.5%), average total direct costs and total earnings were €73,916 and €215,833 in eCare compared to €41,748 and €203,667 in sCare, respectively. PRO showed increasing quality of life and was higher in cohort 1 than cohort 2. Disease activity among CD patients increased after years 3 and 4 in cohorts 1 and 2, respectively.

Conclusion: Telemedicine is cost-effective for patients not receiving biologics. However, treatment with biologics is more expensive for patients enrolled in eCare. Careful attention to PRO in eCare improves quality of life and could prolong time to relapse.