Hans van den Heuvel

6 RESULTS In the SAFE@HOME group of the cost analysis, 97 women were prospectively followed during antenatal care with the digital health platform. The control group consisted of 133 women. Demographics including risk factors for hypertensive complications as reason for inclusion are summarized in Table 1. In the telemonitoring group, significantly less women with a history of preeclampsia (19.6 vs 33.1% in usual care, p = 0.023) and more women with kidney disease (17.5 vs 4.5%, p = 0.001) were included. No differences were observed for age, BMI, ethnicity, education level and parity. Perinatal outcomes Results of maternal and neonatal outcomes did not significantly differ between the two groups, as shown in Table 2. At time of delivery, incidence of hypertensive diagnoses was similar in both groups, i.e. preeclampsia incidence 19.6% in SAFE@HOME group vs 20.3% in control group (p=0.89). Induction of labour was more common in the SAFE@HOME group. However, no significant differences were found for mode of delivery, gestational age and birth weight at delivery, as well as admission to the NICU. Healthcare consumption Use of the predefined visit schedule alongside remote monitoring of blood pressure was associated with less total antenatal visits compared to the control group (median 13 vs 16, p<0.001) (Supplementary Table 1). Ultrasound assessments (median 6 vs 7, p=0.002) and median number of antenatal admission days (median 4 vs 6, p = 0.19) were also lower in the SAFE@HOME group. No difference was found for number of tests of laboratory diagnostics. Cost analysis Table 3 shows the costs associated with use of antenatal care services. In the SAFE@HOME group, a significant cost reduction for direct health care costs of 19.7% or €888 (€3616 vs 4504, p = 0.001) was found. This reduction of costs is mainly attributed to the reduction of antenatal visits and antenatal admission days (Supplementary Table 1). Also, a reduction of costs was achieved as more visits were carried out by hospital midwives instead of gynaecologists (in training), as prescribed by the visit schedule. In the analysis 115 euros was taken into account per participant for use of the digital platform and in-clinic monitoring, based on our calculations. For each euro associated with costs of the digital platform, an average of €7.7 was saved for antenatal care resources. In the additional analysis, costs from a societal perspective were added to direct health care costs. Both travel costs (€245 vs. €280, p<0.001) and loss of productivity costs (€3565 vs €4329, p<0.001) were lower for the SAFE@HOME group. Combined cost calculations of antenatal care resulted in total savings in healthcare costs and societal costs of 18.2% or €1665 (€7485 vs €9150, p < 0.001). SAFE@HOME: COST ANALYSIS 91