Cost-effectiveness of telemonitoring for high-risk pregnant women

Abstract

Purpose

Cost-minimization is a main topic in present-day health care. Clinicians are urged to keep hospital stays as short as possible, also in Obstetrics and Gynaecology Departments. At present stabilized high-risk pregnant women stay in hospital for the sole purpose of being monitored.

Method

In this retrospective study the cost-effectiveness of telemonitoring of such high-risk pregnant women was calculated by analyzing the data of 456 episodes originating from 415 patients of the Ghent University Hospital.

Results and conclusions

It was determined that telemonitoring made a cost-reduction of €145,822 per year possible. However, variables such as educational level, psychosocial situation, time–travel distance from home to the hospital, reimbursement system and actual clinical status were not included. Furthermore, the Belgian health authorities does not provide for a specific code to allow the billing of teleinterpretation of transmitted results.

Introduction

The continuous strain on hospital bed occupancy puts clinicians under great pressure to discharge patients as soon as possible. Telemonitoring can contribute to meeting this problem [1]. Meystre [2] showed that it can deliver health care service without using hospital beds and that it reduces patient travel, time off from work and overall costs. Also Averwater and Burchfield [3] concluded that telemonitoring offers a means to help reduce length of stay and prevent recurrent hospitalization.

High-risk pregnant women may well form one of the target groups for telemonitoring. This study calculates possible cost reduction when telemonitoring is implemented for this target group. If there is a possible cost reduction, it is more conceivable that the implementation of the new technology will be easier. However, the literature contains little reference to possible cost-saving by telemonitoring this specific population. Quemere et al. [4] showed that for high-risk pregnant women home foetal heart rate monitoring is technologically as safe as traditional hospitalization. After conducting a health technology assessment Dawson et al. [5] concluded that domiciliary intervention offered useful practical advantages and savings for both patients and the health service. Brooten et al. [6] concluded that prenatal care delivered at home by advanced practice nurses offers advantages such as a reduction of transportation problems, the need for child care, long waiting lists and the interruption of medical regimens such as bed rest. They arrived at savings of more than 750 total hospital days (pre- and postnatal) to the equivalent of US$ 2,880,000. A study conducted in Geneva (Switzerland) by Petrou et al. [7] found average savings of over CHF 1200 per mother–infant dyad (a pair of two individuals), but it was conducted on women delivering a single infant at term following an uncomplicated delivery and it compared early postnatal discharge combined with home midwifery support with traditional postnatal hospital stay.

Studies in The Netherlands (Birnie et al. [8]; Monincx et al. [9]) demonstrated that domiciliary monitoring by portable cardiotocography (CTG) was safe and feasible and reduced antenatal costs substantially. However, in these studies CTG monitoring was conducted by trained midwives. A Canadian study by Harrison et al. [10] showed no cost reduction if the pregnant women were included in a programme of in-home care by experienced antenatal nurses. Still, the authors concluded that this lack of cost reduction could have been due to the method of data collection (the data for the in-hospital cohort included only antenatal admissions at birth hospitals and thus excluded admission data at other hospitals in the same region).