Cost-Effectiveness Analysis of the Multicenter Scale-Up of the SAFE@Home Telemonitoring Platform for Blood Pressure and Symptoms in Women with Hypertensive Disorders of Pregnancy

Introduction: Health care systems are increasingly pressured by workforce shortages and increasing chronic conditions. Hypertensive disorders of pregnancy (HDP) require frequent monitoring. Telemonitoring of blood pressure (BP) offers a promising alternative for components of hospital care, potentially improving outcomes and reducing costs. Following cost-saving results from the SAFE@home pilot, this study conducts a cost-effectiveness analysis (CEA) of SAFE@home versus care as usual (CAU) at scale.Methods: A CEA was conducted within the SAFE@home II multicenter before-after study. Women with high risk of or established HDP received remote BP monitoring as part of hybrid care. The controls received CAU. Antenatal costs were calculated in euros. Cost-effectiveness was measured as the absolute risk reduction (ARR) in adverse outcome and the incremental cost-effectiveness ratio (ICER) as the cost per adverse outcome prevented.Results: Mean antenatal costs per patient were <euro>6,756 (standard deviation [SD] <euro>5,144) in the SAFE@home group and <euro>7,142 (SD <euro>5,149) in the CAU group, corresponding with a cost reduction of <euro>368 (5.4%) using telemonitoring. The ARR was 4.3% and resulted in a negative ICER. Health care consumption per adverse outcome revealed cost savings during pregnancy of <euro>765 per participant with an adverse outcome. Fewer HDP-related admissions (12.0% vs. 15.5%, p = 0.039) in the SAFE@home group compared with CAU supported cost-effectiveness.Conclusion: This CEA demonstrated that at scale, SAFE@home modestly reduces costs. With lower costs per adverse outcome resulting in a negative ICER, SAFE@home dominates CAU. Future research should explore how telemonitoring can optimize use of resources. In conclusion, addressing adoption barriers is essential to sustainably integrate telemonitoring.