{
    "abstract": "eHealth-facilitated integrated care models (eICMs) have proved effective in improving outcomes for chronically ill patients. However, evidence on cost-effectiveness of eICMs is scarce so far. Allogeneic stem cell transplantation (alloSCT) recipients' post-discharge treatment costs and mortality are greatly influenced by complications. Within the international, multicentric SMILe implementation science project, the eHealth-facilitated SMILe integrated care model (SMILe-ICM) was developed to support patients minimize complications' effects within the first year post-alloSCT. Using initial effectiveness findings from the first center that implemented the SMILe-ICM, this study provides a cost and cost-effectiveness evaluation considering one-year and long-term survival effects, post-discharge costs, and patient-related factors.\nA single-center hybrid effectiveness implementation randomized controlled trial was conducted at a German university hospital from 2/2020 to 8/2022. Eligible alloSCT patients were randomized to the SMILe-ICM or usual care, i.e., one pre-transplant educational nursing visit followed by a physician-led follow-up. The intervention group received usual care plus the SMILe-ICM's four intervention modules (i.e., monitoring of medical/symptom-related parameters, medication adherence, infection prevention, physical activity). All modules were delivered by Advanced Practice Nurses (APNs) in face-to-face visits, combined with continuous online support. Daily, patients entered seventeen medical and symptom-related parameters to the SMILe App, so that APNs could monitor for and investigate possible pre-complication signs. Healthcare utilization costs were assessed at eight time-points (d+30 post-alloSCT-d365) on fourteen self-reported cost indicators and validated against health records. To calculate costs, we applied German standardized unit costs. Cost- and cost-effectiveness were analyzed in five steps: 1.) Calculate total costs, including for the alloSCT inpatient stay and post-discharge follow-up. 2.) Determine life-years gained (survival) as a health benefit unit. 3.) Calculate overall and rehospitalization-free survival estimates. 4.) Calculate the intervention's long-term cost-effectiveness, including extended follow-up, rate of survival until day 1000, and restricted mean survival time. 5.) Contrast these long-term estimates to current post-discharge costs with comparable patient-related factors (age\u00a0\u2265\u00a0or\u00a0<\u00a065, living alone, gender).\nSeventy-two patients participated (n\u00a0=\u00a036/group). Total intergroup healthcare utilization and post-discharge costs differed, but non-significantly. Survival rates improved with the SMILe-ICM (88% vs. 80%) at least until day +1000. Rehospitalization-free survival showed improvement (38% vs. 30%); however, considering this sample size, both findings were nonsignificant. Cost-effectiveness analysis showed an overall post-discharge cost-effectiveness of 35,364.01\u20ac/patient and 6,742\u20ac/life year gained - a mean of 79.21 additional days of life for an intervention investment of 1.464\u20ac/patient in the first year post-alloSCT. One-year cost-effectiveness was highest for patients living alone. Younger age correlated with longer survival but higher costs.\nThe SMILe-ICM appears to offer survival and rehospitalization benefits, particularly for vulnerable groups, e.g., patients living alone. Larger, adequately powered studies are needed to validate these findings.",
    "authors": [
        {
            "affiliation": "Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, Germany; Institute of Nursing Science, Department Public Health, University of Basel, Switzerland. Electronic address: lynn.leppla@uniklinik-freiburg.de.",
            "firstname": "Lynn",
            "initials": "L",
            "lastname": "Leppla"
        },
        {
            "affiliation": "Institute for Medical Biometry and Statistics, University of Freiburg, Germany.",
            "firstname": "Klaus",
            "initials": "K",
            "lastname": "Kaier"
        },
        {
            "affiliation": "Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, Germany.",
            "firstname": "Anja",
            "initials": "A",
            "lastname": "Schmid"
        },
        {
            "affiliation": "Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Chief Medical and Chief Nursing Office - Practice Development and Research, University Hospital Basel, Switzerland.",
            "firstname": "Sabine",
            "initials": "S",
            "lastname": "Valenta"
        },
        {
            "affiliation": "Institute of Nursing Science, Department Public Health, University of Basel, Switzerland.",
            "firstname": "Janette",
            "initials": "J",
            "lastname": "Ribaut"
        },
        {
            "affiliation": "Institute of Nursing Science, Department Public Health, University of Basel, Switzerland.",
            "firstname": "Juliane",
            "initials": "J",
            "lastname": "Mielke"
        },
        {
            "affiliation": "Faculty of Computer Science, University of Applied Sciences Augsburg, Germany.",
            "firstname": "Alexandra",
            "initials": "A",
            "lastname": "Teynor"
        },
        {
            "affiliation": "Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, Germany.",
            "firstname": "Robert",
            "initials": "R",
            "lastname": "Zeiser"
        },
        {
            "affiliation": "Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.",
            "firstname": "Sabina",
            "initials": "S",
            "lastname": "De Geest"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": "The SMILe-ICM appears to offer survival and rehospitalization benefits, particularly for vulnerable groups, e.g., patients living alone. Larger, adequately powered studies are needed to validate these findings.",
    "copyrights": "Copyright \u00a9 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.",
    "doi": "10.1016/j.ejon.2024.102740",
    "journal": "European journal of oncology nursing : the official journal of European Oncology Nursing Society",
    "keywords": [
        "Allogeneic stem cell transplantation",
        "Cost-effectiveness analysis",
        "Delivery of health care",
        "Economic evaluation",
        "Integrated care model",
        "eHealth"
    ],
    "methods": null,
    "publication_date": "2024-11-27",
    "pubmed_id": "39591883",
    "results": "Seventy-two patients participated (n\u00a0=\u00a036/group). Total intergroup healthcare utilization and post-discharge costs differed, but non-significantly. Survival rates improved with the SMILe-ICM (88% vs. 80%) at least until day +1000. Rehospitalization-free survival showed improvement (38% vs. 30%); however, considering this sample size, both findings were nonsignificant. Cost-effectiveness analysis showed an overall post-discharge cost-effectiveness of 35,364.01\u20ac/patient and 6,742\u20ac/life year gained - a mean of 79.21 additional days of life for an intervention investment of 1.464\u20ac/patient in the first year post-alloSCT. One-year cost-effectiveness was highest for patients living alone. Younger age correlated with longer survival but higher costs.",
    "title": "Evaluating the cost, cost-effectiveness and survival of an eHealth-facilitated integrated care model for allogeneic stem cell transplantation: Results of the German SMILe randomized, controlled implementation science trial.",
    "xml": "<Element 'PubmedArticle' at 0x78850548dd00>"
}