(1085) Remote Blood Pressure Monitoring for Postpartum Hypertension: A Cost-Effectiveness Analysis

We conducted a cost-effectiveness analysis of utilizing RBPM to manage postpartum hypertension versus usual care. The modeled RBPM included provision of home blood pressure (BP) cuff, guidance on warning symptoms, instructions on BP self-monitoring twice daily, and clinical staff to monitor population-level BPs and provide clinical recommendations. Usual care was defined as guidance on warning symptoms and recommendation for one outpatient visit for BP monitoring within a week of discharge. We designed a Markov model that ran over 14 one-day cycles. QALYs were calculated over the first year postpartum and reflected the short-term morbidities associated with HDP that, for most birthing people, resolve by two weeks postpartum. Sensitivity analyses were performed to assess strength and validity of the model. Primary outcome was incremental cost effectiveness ratio (ICER) defined as cost needed to gain one quality adjusted life year (QALY). Secondary outcome was incremental cost per readmission averted.

Results:

In the base case scenario, utilizing RBPM was the dominant strategy [Table 1a]. In univariate sensitivity analyses, the most cost-effective strategy was sensitive to baseline probability of normotensive BPs, mild range BPs, or severe range BPs [Table 1b]. Assuming a willingness-to-pay of $100,000 per QALY, utilizing RBPM was cost-effective in 99.96% of simulations in a Monte Carlo analysis. Using readmissions averted as a secondary effectiveness outcome, the incremental cost per readmission averted was $118.23.

Conclusion: Remote blood pressure management of postpartum hypertension is cost saving with better outcomes compared to usual care. These data support broad implementation of RBPMs for birthing people with hypertensive disorders of pregnancy.