Retrospective evaluation of regional telemedicine team meetings for multiple sclerosis (MS) patients: Experience from the Caen MS expert center in Normandy, France

INTRODUCTION

Multiple sclerosis (MS) is a demyelinating disease requiring multidisciplinary care coordination. Recent development of diagnosis criteria and disease modifying treatments have encouraged the setup of regional team meetings by MS expert centers, known as CRC Sep, to improve the quality of care provided to patients with complex cases. The CRC Sep in Caen initiated regional telemedicine meetings named Télé-SEP, operating since 2016. The objective of this study was to evaluate the Télé-SEP used by neurologists, on MS patient care management in Normandy.

METHODS

An internal ex-itinere evaluation was conducted with a retrospective descriptive observational study from July 2016 to June 2018. The Télé-SEP meetings were organized with 41 neurologists using a regional telemedicine platform (Therap-e). Data were collected from online records and a declarative voluntary survey. Twenty indicators were classified in the categories: volume of activity, clinical profile, quality and impact.

RESULTS

Fifteen meetings were organized with a median of 13 senior neurologists. One hundred forty MS cases were discussed and there was a 33% increase in the second year of Télé-SEP. Median patient age was 44 years with a 72-month median length of disease. Most patient cases required second-line treatment. Relapsing remitting MS was diagnosed in 51.4% of cases. Télé-SEP satisfaction rate was 4.5/5 and 96% of neurologists applied the medical decisions and recommendations given in the meetings.

CONCLUSION

Without Télé-SEP, 54.5% of patients would have been referred to a physical expert consultation in the CRC Sep. This study showed the feasibility and relevance of regional telemedicine team meetings for MS cases in the Normandy region.

Cost-effectiveness analysis of a telemonitoring program on patients with heart failure in Normandy: an 8-year retrospective analysis (2009–2017)

Background

SCAD is a 3-month telemonitoring program for HF patients, associated with therapeutic education, proposed after an acute HF episode. SCAD is based on an interactive algorithm allowing to generate educative messages and alarms based on patients' responses registered on a digital tablet. It is funded by the French Health Insurance through a pilot program: ETAPES (470€/patient).

Purpose

To describe the profile of patients using SCAD & assess the medico-economic impact of the SCAD system.

Methods

Multicenter retrospective cohort study using SCAD data matched with French Health Insurance data. All patients telemonitored by SCAD in 7 centers have been included, since 01/01/2010 to 12/31/2016. Only direct costs were considered, estimated from a societal perspective limited to reimbursements. Analyses were performed to assess the difference in healthcare consumptions and costs between the year before and the year after inclusion in the SCAD program. Patients who died in the 12 months after SCAD initiation were excluded.

Results

627 patients benefited from SCAD program between 01/01/2010 and 12/31/2016 and were retrieved in French Health Insurance data through probabilistic matching. Out of the 627 patients, 99 died in the 12 months after SCAD initiation. Analyses were performed on 528 patients.72.2% were male, mean age was 66.0 years old and mean BMI 28.2. HFrEF represented 51.9% of patients, HFmrEF 25.9% and HFpEF 22.2%. 58.0% were in NYHA class 2 at baseline, 29.2% in class 3, 8.5% in class 1 and 4.3% in class 4. Mean Charlson Comorbidity Index score was 2.6 at baseline. Patients reported their level of fatigue (10 representing significant fatigue) and morale (10 = good morale) at baseline: mean fatigue=4.0/10 & mean morale=7.4/10. Medico economic results are presented in table 1 and show an important & significant decrease of hospitalizations costs and some transfer of cost toward ambulatory care.

Conclusion

On the year following remote monitoring, total health expenditure has been reduced by 18% on average (mean=3 210€/patient) and 42% in median (5 500€/patient) vs 12 months before.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): This analysis has been funded through an institutional grant from Amgen