Abstract
Objectives
Gestational hypertensive disorders (GHD) are common pregnancy-related disorders associated with adverse outcomes. Adequate blood pressure monitoring is essential to mitigate these risks. Remote monitoring (RM) and patient self-monitoring (PSM) may provide alternatives to conventional care. However, their cost-effectiveness remains unassessed. This study evaluated the cost-effectiveness of RM and PSM compared with conventional care for pregnant women at risk of GHD.Methods
This trial-based economic evaluation used PREMOM II trial data and InterMutualistic Agency cost data. A cost-utility analysis was conducted from a healthcare payer perspective, with results expressed as costs per quality-adjusted life year (QALY) gained. Uncertainty was assessed through one-way and probabilistic sensitivity analyses.Results
At the mother-infant dyad level, RM and PSM generated small QALY gains versus conventional care (0.001 and 0.004 QALYs) and higher costs (€337.91 and €898.45). ICERs were €304,046/QALY for RM and €222,483/QALY for PSM, both exceeding the NICE willingness-to-pay reference range of £25,000-£35,000/QALY. In the full incremental analysis, RM was extendedly dominated by PSM. Probabilistic sensitivity analysis showed substantial uncertainty across comparisons.Conclusions
There is insufficient evidence to determine the relative cost-effectiveness of RM or PSM compared with conventional care. Consequently, the analysis provides no evidence to justify reimbursement.Trial registration
The study is registered with ClinicalTrials.gov NCT04031430 on November 11, 2018.