EPOCA Tele-Monitoring System for Older Adults at High Risk of Hospitalization: Budget Impact and Cost-Effectiveness Analysis.

Background: France's aging population faces high rates of chronic illness, multimorbidity, and avoidable hospitalizations, placing pressure on an already strained health care system. Remote monitoring systems have shown promise in improving care coordination and reducing acute care use. Objective: The objective of this study was to assess the cost-effectiveness of the EPOCA remote monitoring system, implemented within the Vigie-Age framework, compared to the standard of care for older adults with multiple chronic conditions. Methods: Using data from the Vigie-Age Article 51 pilot study (with 722 participants, including 408 participants 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 visits, 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. Results: EPOCA was associated with a reduction in emergency department visits by 54% and in hospitalizations by 46%, cutting the average hospital stay from 55.6 (SD 51.7) to 30.6 (SD 27.8) days. Total costs per patient were €29,165 (EUR €1=US $1.13) with EPOCA and €39,929 for standard of care, representing 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 the results. EPOCA had a 90% probability of being dominant and a 95% probability of being cost-effective at a €30,000 per QALY threshold. Conclusions: On the basis of currently available evidence, EPOCA may be a cost-effective strategy for older patients at high risk of hospitalization. It could reduce health care use while improving outcomes, supporting its integration into national older adult care pathways and reimbursement by the French NHI.