Hans van den Heuvel

ABSTRACT Objective To perform a cost analysis of the use of a new care pathway with a digital health platform for blood pressure telemonitoring for women at risk of preeclampsia. Study design This is a cost analysis of a case-control study with women with chronic hypertension, history of preeclampsia, maternal cardiac or kidney disease at intake of pregnancy. Antenatal care with a reduced visit schedule and a digital health platform (SAFE@HOME, n=97) was compared to a retrospective control group (n=133) with usual care without self-monitoring. Main outcome measures Costs per pregnancy (€) of healthcare consumption of antenatal clinic visits, ultrasound assessments, antenatal admissions, laboratory and other diagnostic tests, and societal costs such as traveling and work absence. Results Baseline characteristics and perinatal outcomes were similar between both groups. A significant reduction of antenatal visits, ultrasounds and hypertension-related admissions was associated with use of the digital platform. In the SAFE@HOME group, costs of antenatal care, including the costs of the digital platform, were 19.7% lower compared to the control group (median €3616 [IQR 3071 – 5329] vs €4504 [IQR 3515-6923], p=0.001). Total costs per pregnancy, including societal costs, were also reduced (€7485 [IQR 6338 - 10,173] vs €9150, [IQR 7546 - 12,286] p<0.001). Each euro invested in the platform saved on average €8 of antenatal care resources. Conclusions The use of a digital platform for blood pressure and symptom monitoring in antenatal care for high-risk women is associated with lower costs compared to conventional care, while observed maternal and neonatal outcomes are similar. CHAPTER 6 86