Norwich Medical School, University of East Anglia, Norwich, UK.
Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
Ultrasound Obstet Gynecol. 2019 Apr;53(4):496-502. doi: 10.1002/uog.19041. Epub 2019 Mar 12.
Traditional blood-pressure monitoring in hypertensive pregnant women requires frequent visits to the maternity outpatient services. Home blood-pressure monitoring (HBPM) could offer a cost-saving alternative that is acceptable to patients. The aim of this study was to undertake a health economic analysis of HBPM compared with traditional monitoring in hypertensive pregnant women.
This was a cost-minimization study of hypertensive pregnant women who had HBPM with or without the adjunct of a smartphone application (App), via a specially designed pathway, and a control group managed according to the local protocol of regular hospital visits for blood-pressure monitoring. Outcome measures were the number of outpatient visits, inpatient bed stays and investigations performed. Maternal, fetal and neonatal adverse outcomes were also recorded. Health economic analysis was performed using direct cost comparison of the study dataset and process scenario modeling.
The HBPM group included 108 women, of whom 29 recorded their results on the smartphone App and 79 in their notes. The control group comprised 58 patients. There were significantly more women with chronic hypertension in the HBPM group than in the control group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly longer duration of monitoring (9 weeks vs 5 weeks, P = 0.004) and started monitoring at an earlier gestational age (30.0 weeks vs 33.6 weeks, P = 0.001) compared with the control group. Despite these differences, the mean saving per week for each patient using HBPM compared with traditional monitoring was £200.69, while for each HBPM patient using the smartphone App, the weekly saving was £286.53 compared with the control group. The process modeling method predicted weekly savings of between £98.32 and £245.80 per patient using HBPM compared with traditional monitoring.
HBPM in hypertensive pregnancy appears to be cost saving compared with traditional monitoring, without compromising maternal, fetal or neonatal safety. Larger studies are required to confirm these findings. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
传统的高血压孕妇血压监测需要频繁到妇产科门诊就诊。家庭血压监测（HBPM）可能是一种更经济的替代方案，且患者更易接受。本研究旨在对高血压孕妇 HBPM 与传统监测进行卫生经济学分析。
这是一项针对高血压孕妇的成本最小化研究，这些孕妇通过专门设计的途径使用 HBPM，或通过 HBPM 加智能手机应用程序（App）进行监测，而对照组则按照当地定期医院就诊监测血压的方案进行管理。观察指标为门诊就诊次数、住院天数和检查次数。还记录了母婴和新生儿不良结局。采用研究数据集的直接成本比较和流程情景建模进行卫生经济学分析。
HBPM 组纳入 108 例孕妇，其中 29 例将结果记录在智能手机 App 上，79 例记录在病历中。对照组包括 58 例患者。HBPM 组中慢性高血压患者明显多于对照组（49.1%比 25.9%，P=0.004）。HBPM 组监测时间明显长于对照组（9 周比 5 周，P=0.004），且开始监测的妊娠周数更早（30.0 周比 33.6 周，P=0.001）。尽管存在这些差异，但与传统监测相比，每位患者每周使用 HBPM 的平均节省费用为 200.69 英镑，而对于每位使用智能手机 App 的 HBPM 患者，与对照组相比，每周节省费用为 286.53 英镑。流程建模方法预测，与传统监测相比，每位患者每周使用 HBPM 的节省费用在 98.32 英镑至 245.80 英镑之间。
与传统监测相比，高血压孕妇的 HBPM 似乎具有成本效益，且不影响母婴或新生儿的安全性。需要更大规模的研究来证实这些发现。版权所有©2018 ISUOG。由 John Wiley & Sons Ltd 出版。
