EPOCA Telemonitoring System in Older Adults at High Risk for Hospitalization in France: Budget Impact and Cost-Effectiveness Analysis.

Abstract

France's aging population faces high rates of chronic illness, multimorbidity, and avoidable hospitalizations, placing pressure on an already strained healthcare system. Remote monitoring systems (RMS) have shown promise in improving care coordination and reducing acute care use. The objective of this study is to assess the cost-effectiveness of the EPOCA RMS, implemented within the Vigie-Age framework, compared to standard care (SOC) for older adults with multiple chronic conditions. Using data from the Vigie-Age Article 51 pilot study (722 participants including 408 with long term follow-up), a cost-utility analysis was conducted over a 10-year lifetime horizon. A Markov model with daily cycles simulated transitions across health states: at home, emergency department (ED) visit, hospitalization, and death. Analyses were conducted from both the French National Health Insurance (NHI) and collective perspectives. Direct medical costs, including hospital, outpatient, and intervention costs, were included. Health outcomes were measured in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses assessed model robustness. EPOCA was associated with a reduction of ED visits by 54% and hospitalizations by 46%, cutting average hospital stay from 55.6 to 30.6 days. Total costs per patient were €29,165 with EPOCA vs. €39,929 for SOC, a €10,764 saving from the collective perspective, and a €7,430 saving from the NHI perspective. EPOCA yielded 0.04 additional QALYs and remained cost-saving even at higher program costs. Sensitivity analyses confirmed the robustness of results. EPOCA had a 90% probability of being dominant and a 95% probability of being cost-effective at a €30,000/QALY threshold. Based on currently available evidence, EPOCA may be a cost-effective strategy for elderly patients at high risk of hospitalization. It could reduce healthcare utilization while improving outcomes, supporting its integration into national elderly care pathways and reimbursement by the French NHI.