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 €6,756 (standard deviation [SD] €5,144) in the SAFE@home group and €7,142 (SD €5,149) in the CAU group, corresponding with a cost reduction of €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 €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.