RESUMO
BACKGROUND: Remote monitoring in obstetrics is relatively new; some studies have shown its effectiveness for both mother and child. However, few studies have evaluated the economic impact compared to conventional care, and no cost analysis of a remote monitoring prenatal follow-up program for women diagnosed with gestational hypertensive diseases (GHD) has been published. OBJECTIVE: The aim of this study was to assess the costs of remote monitoring versus conventional care relative to reported benefits. METHODS: Patient data from the Pregnancy Remote Monitoring (PREMOM) study were used. Health care costs were calculated from patient-specific hospital bills of Ziekenhuis Oost-Limburg (Genk, Belgium) in 2015. Cost comparison was made from three perspectives: the Belgian national health care system (HCS), the National Institution for Insurance of Disease and Disability (RIZIV), and costs for individual patients. The calculations were made for four major domains: prenatal follow-up, prenatal admission to the hospital, maternal and neonatal care at and after delivery, and total amount of costs. A simulation exercise was made in which it was calculated how much could be demanded of RIZIV for funding the remote monitoring service. RESULTS: A total of 140 pregnancies were included, of which 43 received remote monitoring (30.7%) and 97 received conventional care (69.2%). From the three perspectives, there were no differences in costs for prenatal follow-up. Compared to conventional care, remote monitoring patients had 34.51% less HCS and 41.72% less RIZIV costs for laboratory test results (HCS: mean 0.00 [SD 55.34] vs mean 38.28 [SD 44.08], P<.001; RIZIV: mean 21.09 [SD 27.94] vs mean 36.19 [SD 41.36], P<.001) and a reduction of 47.16% in HCS and 48.19% in RIZIV costs for neonatal care (HCS: mean 989.66 [SD 3020.22] vs mean 1872.92 [SD 5058.31], P<.001; RIZIV: mean 872.97 [SD 2761.64] vs mean 1684.86 [SD 4702.20], P<.001). HCS costs for medication were 1.92% lower in remote monitoring than conventional care (mean 209.22 [SD 213.32] vs mean 231.32 [SD 67.09], P=.02), but were 0.69% higher for RIZIV (mean 122.60 [SD 92.02] vs mean 121.78 [SD 20.77], P<.001). Overall HCS costs for remote monitoring were mean 4233.31 (SD 3463.31) per person and mean 4973.69 (SD 5219.00) per person for conventional care (P=.82), a reduction of 740.38 (14.89%) per person, with savings mainly for RIZIV of 848.97 per person (23.18%; mean 2797.42 [SD 2905.18] vs mean 3646.39 [SD 4878.47], P=.19). When an additional fee of 525.07 per month per pregnant woman for funding remote monitoring costs is demanded, remote monitoring is acceptable in their costs for HCS, RIZIV, and individual patients. CONCLUSIONS: In the current organization of Belgian health care, a remote monitoring prenatal follow-up of women with GHD is cost saving for the global health care system, mainly via savings for the insurance institution RIZIV.
