Dtsch Med Wochenschr 2012; 137 - A374
DOI: 10.1055/s-0032-1323537

Effectiveness and efficiency for ambulatory care assisted by mobile technological devices

J Zerth 1, A Reichert 1, J Besser 1
  • 1International DiaLog College and Research Institute, Fürth

Introduction: There is an on-going debate in the international literature about the interplay between informal and formal care but aspects of assistive technologies are rarely discussed. In our paper, we evaluate the impact of a mobile assistive technology that may increase the self-sufficiency and autarky of end users and informal caregivers in aspects of costs of care and quality of life. Methods: The focused mobile assistive system aims at reducing the patient’s probability to need inpatient care. We use a Markov model that encompasses stage depended costs for dementia. Stages represent care arrangements that may be directly influenced by the mobile device and its corresponding service structure. The initial stage includes persons being detected for dementia but not getting any formal or informal care. Furthermore, two outpatient stages are embedded as well as absorptive stages for inpatient care and death. A random virtual sample of about 300.000 people aged 65 and more was included. A continuous incidence of 3.2% is assumed. We compute the cumulative cost-effectiveness after eight years which is proxy for the maximum period of living with dementia. The costs range between 2.600 EUR (without care) and 40.000 EUR (inpatient care). Results: We predict a surplus of 1.892 additional life years using the mobile technology advice. Moreover, there is a cumulative cost advantage of about 69 million EUR. But, we have to consider the skewness of the cost distribution. Hence, an incremental cost effectiveness ratio is a better mean to assess the technology's effectiveness. Conclusion: The economic impact of an assistive technology presumes a high level of acceptance. Moreover, there exist some countervailing effects because lower inpatient costs need to outweigh the informal care costs by prolonging the outpatient period. Hence, aspects of endusers’ willingness-to-pay and the implementation in the benefit basket are important for further research