Remote Therapeutic Monitoring and Infection-Related Health Care Resource Utilization in Patients With Hematologic Malignancies.

Abstract

Infection remains a leading cause of death in patients with hematologic malignancies, necessitating better strategies to monitor for and identify infections earlier. In this study, we investigated whether an electronic patient-reported outcome (ePRO)-based remote therapeutic monitoring (RTM) platform can reduce infection-related health care utilization compared with traditional monitoring methods. This was a retrospective cohort study of adults with hematologic malignancies receiving anticancer therapy at five community clinics with the Canopy ePRO-based RTM platform integrated into their electronic medical record. The dual primary outcomes of this study were infection-related health care utilization (emergency department [ED] visits and hospital admissions) and outpatient antibiotic use during follow-up. Propensity score weighting was used to balance patient characteristics between groups. Health care costs were estimated by applying unit costs to weighted event rates for ED visits and hospitalizations. A total of 349 patients were enrolled and active in the ePRO program (active ePRO) and 1,296 were not enrolled. In both unadjusted and weighted adjusted analyses, patients in the active ePRO group had significantly higher rates of outpatient antibiotic use (weighted relative risk ratio [RR], 1.20 [95% CI, 1.02 to 1.42]) and lower incidences of infection-related ED visits (weighted RR, 0.66 [95% CI, 0.46 to 0.96]) and hospital admissions (weighted RR, 0.48 [95% CI, 0.25 to 0.89]). Estimated combined savings with ePRO was USD$977,695 for every 1,000 patients per year. ePRO RTM during treatment for hematologic malignancies was associated with a significant reduction in infection-related health care utilization and cost of care. ePRO monitoring may be increasingly beneficial as therapies with more complex toxicity profiles gain traction.