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Befürchtungen hinsichtlich zunehmender ökonomischer Einflüsse im Gesundheitswesen werden meist plakativ mit dem Schlagwort der Ökonomisierung zum Ausdruck gebracht. Während sich der ärztliche Behandlungsauftrag jedoch medizinethisch begründen lässt, ergibt sich die ökonomische Wirklichkeit aus einem komplexen Zusammenspiel von gesundheitspolitischen Rahmenbedingungen und Ressourcenzuteilungen sowie den entsprechenden Reaktionen der Akteur*innen auf diese Vorgaben. Zur Beantwortung der Forschungsfragen, wie sich strukturell angelegte Spannungsfelder im Klinikalltag niederschlagen und wie Akteur*innen diese handhaben, griffen die Autor*innen auf Einzelinterviews und ein Fokusgruppeninterview mit jeweils inhaltsanalytischer Auswertung sowie auf die phänomenologische Analyse zurück. Die so gewonnenen Erkenntnisse sollten einen Beitrag leisten für ein besseres Verständnis zwischen Medizin und Ökonomie im Klinikalltag.

Background: Evidence that home telemonitoring for patients with chronic heart failure (CHF) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage. Methods: Between January 2010 and June 2013, patients with a confirmed diagnosis of CHF were enrolled and randomly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system (Motiva\(^{®}\)). The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio (ICER) established by the groups' difference in total cost and in the combined clinical endpoint "days alive and not in hospital nor inpatient care per potential days in study" within the follow-up of 12 months. Results: A total of 621 predominantly male patients were enrolled, whereof 302 patients were assigned to the intervention group and 319 to the control group. Ischemic cardiomyopathy was the leading cause of heart failure. Despite randomization, subjects of the control group were more often in NYHA functional class III-IV, and exhibited peripheral edema and renal dysfunction more often. Additionally, the control and intervention groups differed in heart rhythm disorders. No differences existed regarding risk factor profile, comorbidities, echocardiographic parameters, especially left ventricular and diastolic diameter and ejection fraction, as well as functional test results, medication and quality of life. While the observed baseline differences may well be a play of chance, they are of clinical relevance. Therefore, the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances. Conclusions: CardioBBEAT provides prospective outcome data on both, clinical and health economic impact of home telemonitoring in CHF. The study differs by the use of a high evidence level randomized controlled trial (RCT) design along with actual cost data obtained from health insurance companies. Its results are conducive to informed political and economic decision-making with regard to home telemonitoring solutions as an option for health care. Overall, it contributes to developing advanced health economic evaluation instruments to be deployed within the specific context of the German Health Care System.