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

Overview

Journal PLoS Med

Specialty General Medicine

Date 2024 Oct 9

PMID 39383175

Authors

Lukas Schoner

David Kuklinski

Laura Wittich

Viktoria Steinbeck

Benedikt Langenberger

Thorben Breitkreuz

Felix Compes

Mathias Kretzler

Ursula Marschall

Wolfgang Klauser

Mustafa Citak

Georg Matziolis

Daniel Schrednitzki

Kim Grasbock

Justus Vogel

Christoph Pross

Reinhard Busse

Alexander Geissler

Affiliations

Soon will be listed here.

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.

Citing Articles

Satisfied with the worst health outcomes or unsatisfied with the best: explaining the divergence between good patient-reported outcomes and low satisfaction and vice versa among knee arthroplasty patients - a retrospective cohort study.

Schoner L, Steinbeck V, Busse R, Marques C J Orthop Surg Res. 2025; 20(1):88.

PMID: 39849486 PMC: 11755965. DOI: 10.1186/s13018-025-05507-7.

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