Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial

Laurene Bernard; Verushka Valsecchi; Thibault Mura; Safa Aouinti; Guillaume Padern; Rosanna Ferreira; Jenica Pastor; Christian Jorgensen; Grégoire Mercier; Yves-Marie Pers

doi:10.1016/j.jbspin.2022.105368

Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial

Joint Bone Spine. 2022 Oct;89(5):105368. doi: 10.1016/j.jbspin.2022.105368. Epub 2022 Mar 4.

Affiliations

¹ IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France.
² Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France.
³ Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France.
⁴ IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France. Electronic address: ympers2000@yahoo.fr.

PMID: 35248737
DOI: 10.1016/j.jbspin.2022.105368

Abstract

Objectives: Rheumatoid arthritis (RA) is a prevalent and disabling disease that is the source of significant direct and indirect costs. The current recommended therapeutic strategy is based on the rapid introduction of therapy with conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs) combined with regular disease monitoring by the rheumatologist. The onerous nature of such intense monitoring has motivated the development of new, less demanding strategies such as telemedicine. This study aimed to estimate the cost-effectiveness of the connected monitoring of RA patients initiating a new DMARD therapy versus conventional monitoring.

Methods: An economic evaluation based on a randomized controlled trial of 89 patients was conducted. The patients in the intervention group (n=45) were monitored using a connected monitoring interface on a smartphone, while patients in the control group (n=44) were conventionally monitored. Health outcomes were measured as the gain in quality-adjusted life-years (QALYs), assessed using the EuroQol-5D questionnaire. Resource use and health outcomes were collected alongside the trial and at the six-month follow-up using application data and the related clinical case manager time, visits, hospitalisations, and transport records. These outcomes were valued using externally collected data on unit costs and QALY weights.

Results: Compared to conventionally monitored patients, patients receiving connected monitoring had a slightly greater but not significant gain in the average QALY of 0.07. The economic analysis found that connected monitoring resulted in a significant cost reduction of 72€ (2927€ vs. 2999€, P<0.01). The incremental cost-utility ratio of the intervention was equal to -1,029€ per QALY (95% CI: -32,033; +24,625) with a 97.8% chance of being cost-effective at a threshold of 30,000€ per QALY gained.

Conclusion: Implementing EULAR recommendations for RA patients initiating a DMARD treatment using connected monitoring is more efficient and less expensive than conventional care.

Clinical trial registration number: ClinicalTrials.gov (NCT03005925).

Keywords: Connected monitoring; Cost-effectiveness; Medico-economic study; QALY; Rheumatoid arthritis; Telemedicine.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / diagnosis
Arthritis, Rheumatoid* / drug therapy
Cost-Benefit Analysis
Humans
Quality-Adjusted Life Years
Telemedicine*

Substances

Antirheumatic Agents

Associated data

ClinicalTrials.gov/NCT03005925