Assessment of Cost-Effectiveness on Remote Monitoring for Cardiovascular Devices in Japan

BACKGROUND: 2018 revision of the health insurance reimbursement in Japan brought additional fee for Cardiovascular Implantable Electronic Devices (CIEDs) Management by Remote Monitoring. The adaption of CIEDs Remote Monitoring has already been recommended by the societies, but the cost-effectiveness evaluation about the system has not been enough. This research was designed, therefore, to evaluate the cost-effectiveness about CIEDs Remote Monitoring in Japan.

METHODS: A systematic review was conducted along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Certain criteria and search strategy were pre-defined to identify studies that could be included into this research. The process of the quality assessments was planned by Critical Appraisal Skills Programme (CASP). Quality Adjusted Life Years (QALYs) that were extracted from the included studies would be calculated into Incremental Cost-Effectiveness Ratio (ICER) with the reimbursement amount in Japan.

RESULTS: Three studies met the systematic review criteria after the selection along with PRISMA flow diagram. The quality of the included studies was assured by CASP Checklists designed for RCT and Cohort Study. ICERs from the selected studies were provided as 569,697 JPY, 1,220,000 JPY, and 311, 111 JPY for the patient groups enrolled with Remote Monitoring system.

CONCLUSION: ICERs for CIEDs Remote Monitoring were demonstrated as the cost-effective under the threshold set by Central Social Insurance Medical Council (Chuikyo). As this study put the validity of the cost-effectiveness approach in a certain field in Japan, this kind of evaluation should be performed on more areas along with the guideline by Chuikyo.