Cost-effectiveness of telehealth with remote patient monitoring for postpartum hypertension

OBJECTIVE: Evaluate cost-effectiveness of telehealth with remote monitoring for postpartum hypertensive disorders from the hospital's perspective. METHODS: A decision tree was developed using results from a non-randomized controlled trial comparing telehealth to standard outpatient blood pressure monitoring. At discharge, postpartum women with a hypertensive disorder received a Bluetooth tablet, blood pressure monitor, and scale to submit vitals daily for 6 weeks. Women were managed and treated with a standard protocol. We performed a cost-effectiveness analysis using data from the hospital, device manufacturer supplied charges, and utilities. A cost-effectiveness threshold was set at 100, 000/quality-adjusted life years. One-way and two-way sensitivity analyses were performed to evaluate the robustness of our results compared to baseline assumptions. RESULTS: Telehealth monitoring significantly reduced postpartum readmissions, 3. 7% (8/214) versus 0. 5% (1/214), and resulted in higher quality-adjusted life years. Telehealth monitoring was cost-effective and cost-saving. Average cost of telehealth per patient was 309, and was cost-effective to a cost of 420 per patient. Telehealth monitoring remained cost-effective down to an admission cost of 10, 999 compared to our baseline-estimate for the average admission cost of 14, 401. Telehealth monitoring also remained cost-effective when the postpartum readmission rate was 3. 0% or higher with standard monitoring. With a cost saving of 93 per patient and an estimated 333, 253 pregnant women with hypertension in the US a year, telehealth could reduce health care costs in the US by approximately 31 million a year. CONCLUSIONS: This study demonstrates telehealth with remote blood pressure monitoring may be a cost-effective and cost-saving solution for management of postpartum hypertension.