Applying telemonitoring (TMon) post-admission for COPD, at scale: Preliminary findings from a large European trial

Introduction: TMon for COPD has been associated with a reduced mortality, but was not deemed cost-effective (1). RCTs may not be the optimal trial design. Methods: The United4Health project in 6 sites across 4 EU countries, compared a TMon intervention with historical comparators discharged from hospital 1 year prior (ratio 1:2). Although devices differed by country, we used a step-down approach of High then Moderate then Low Intensity TMOn for up to 1 year. Model for Assessment of Telemedicine protocols assessed key outcomes including safety; effectiveness; patient and economic aspects; organisational impact; ethical and legal issues. Results: Most sites experienced procurement delays, IT barriers and patient/staff reticence. Only 2460 from a target of 4000 patients, were eventually assessed for eligibility and following exclusions and losses, only 483 TMon and 884 Comparators were included in the first analysis: Key findings: 1. When allowing for confounders, Comparators were x3.6 more likely to be hospitalised (p 2. Patients were accepting of TMon, feeling it enhanced their care 3. There is an overall reduction in the costs of approximately €750/pt using TMon, mainly explained by the reduction in admissions but there was significant variation by country Conclusion: TMon following acute admission for COPD is currently not able to be implemented at scale under current conditions. However, it is safe and popular with users and confers some clinical benefit with mixed evidence of cost-effectiveness according to different settings. Ref: 1. BMJ 2012; 344: e3874 Funding: EU Integrated Care Technology Policy Support Programme (CIP-ICT-PSP-2012-6).