Hans van den Heuvel

DISCUSSION Main findings In the SAFE@HOME study, antenatal care with use of a digital health platformand predefined visit schedule was compared to traditional monitoring of women at increased risk of hypertensive complications in pregnancy. In the SAFE@HOME group, a reduction was found in antenatal visits, ultrasound assessments and antenatal hypertension-related admission, compared to the control group. This study found no differences with regards to (adverse) perinatal outcomes between the two groups. Results of the cost analysis showed a significant cost reduction for costs of antenatal care services; €3616 in the SAFE@HOME group compared to €4504 in conventional care, median cost difference €888, p = 0.001. This result accounted for a 19.7% cost reduction. When comparing means of total healthcare costs, a difference was found of € 1338 or 18.7% (€5805 vs €7143). Reduction of costs was primarily related to a reduction in clinic visits and a shift of type of obstetric care professionals that performed these visits. Moreover, a shorter length of antenatal hospital admissions was found in the SAFE@HOME group. When adding costs of travelling and work absence (societal costs), costs decreased from €9150 in usual care to €7485 with use of the digital platform (median cost difference €1665 or 18.2%, p<0.001) (mean cost difference €2174). Comparison with the literature Several cost studies of home- or self-monitoring of blood pressure in the hypertensive pregnant population have been performed recently. 15-17 In our study, telemonitoring was started before 20 weeks of gestation. In contrast, participants in the published studies started remote monitoring later in pregnancy, when hypertensive complications occurred, meaning at time of diagnosis of hypertension. In these studies, self-monitoring of blood pressure also resulted in cost savings, mostly achieved by a reduction in hospital visits and antenatal admissions as compared to conventional surveillance. For example, Xydopoulos et al. found a saving of EUR 226-323 per patient per week of home monitoring after diagnosis of hypertension with their results of a case-control study. 17 In the cost-modeling study of Barton et al, outpatient management of patients with gestational hypertension was found cost-effective as the need for inpatient care decreased. 15 Only one study used in-clinic monitoring of patients’ home measurements. 16 The use of our digital platform was associated with a reduction of health care consumption and thus with a total reduction of costs. These reductions are consistent with recent studies of remote pregnancy monitoring in different settings (i.e. start of home-monitoring at diagnosis of hypertension in pregnancy). 18-19 Therefore, blood pressure and symptom monitoring with help of a digital platform is likely to be a cost-saving approach to antenatal care. CHAPTER 6 94