Hans van den Heuvel

6 INTRODUCTION Up to 10% of pregnancies is complicated by hypertensive disorders, and this proportion continues to rise. 1 Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, are important causes of maternal and perinatal morbidity and mortality, and require intensified surveillance with frequent monitoring. 2 During repeated antenatal visits, maternal as well as fetal condition are checked to detect onset or progression of hypertensive disease. These planned and emergency visits as well as hospital admissions pose a substantial burden to perinatal care resources. 3 Remote monitoring in addition to antenatal visits has potential to achieve higher-value care for women at high risk for hypertension. 4 Moreover, self-monitoring of blood pressure in pregnancy is increasingly accepted as an alternative to frequent clinic visits. 5,6 Therefore, we developed a digital health platform that allows for repeated blood pressure measurements in combination with preeclampsia symptom reporting during pregnancy. 7 Obstetric care professionals in-clinic monitor these self-measurements and anticipate on values exceeding set thresholds. Togetherwith a predefined antenatal visit schedule from16weeks gestational age onwards, this platform was integrated in antenatal care for patients at increased risk of development of preeclampsia. While patient outcomes and experiences are the primary focus of evaluation of any new intervention, economic impact is also important to allowwidespread adoption. Therefore, in this study we performed a cost analysis of use of a digital health platform and new-developed visit schedule in antenatal care for women at risk of hypertensive complications, compared to traditional care without remote monitoring. We used data of healthcare consumption from the SAFE@HOME study, a case-control study of the digital health strategy, to compare direct healthcare costs as well as societal costs of antenatal care. METHODS Study design In the SAFE@HOME study, a prospective group of pregnant women at risk of preeclampsia used a digital health platform facilitating a novel care pathway. This group was compared with a retrospectively selected group of women managed with traditional monitoring. Methods and results are described in detail elsewhere (Chapter 6). Population Pregnant women with a singleton pregnancy were included if they presented for antenatal SAFE@HOME: COST ANALYSIS 87