431: Cost-effectiveness of telehealth blood pressure monitoring in postpartum women with hypertension

Abstract

Postpartum hypertension is the leading cause of postpartum readmissions in the US. The objective of this study was to evaluate the cost-effectiveness of telehealth blood pressure monitoring of postpartum women with hypertensive disorders from the hospital’s perspective. A decision tree was developed based on results from a non-randomized controlled trial comparing telehealth to standard outpatient blood pressure monitoring. Upon postpartum discharge from the hospital, we issued remote monitoring equipment including a Bluetooth tablet, blood pressure cuff, and scale to postpartum women at a single academic center who were diagnosed with a hypertensive disorder in the antenatal or postnatal period. Patients transmitted vital signs daily to a telehealth nurse, who used an outpatient treatment algorithm to monitor patients, manage antihypertensive medications, or refer for emergent care if symptomatic. We followed patients for 6 weeks and performed cost-effectiveness analysis by using data from hospital and device manufacturer supplied charges and literature-derived utilities. A cost-effectiveness threshold was set at $100,000/quality-adjusted life years. One-way sensitivity analyses were performed to evaluate the robustness of our baseline assumptions. 214 telehealth and 214 control participants were enrolled. Telehealth monitoring significantly reduced postpartum readmissions, from 3.7% (8/214) to 0.5% (1/214). Our study demonstrated that telehealth monitoring was not only cost-effective, but cost-saving. The telehealth cost per patient was $319 and found to be cost-effective up to $423 per patient. Similarly, telehealth monitoring remained cost-effective down to an admission cost of $11,245 compared to our average admission cost of $14,401. Telehealth monitoring also remained cost-effective down to an admission rate of 2.9% with standard monitoring. Our study demonstrates that telehealth blood pressure monitoring of postpartum women with hypertension is cost-effective, cost-saving, and reduces postpartum readmissions.