Cost-Savings Analysis of an Outpatient Management Program for Women with Pregnancy-Related Hypertensive Conditions

Abstract

The aim of this study was to evaluate the cost savings of outpatient management services for women with pregnancy-related hypertensive conditions. The outpatient management program included verbal and written patient education related to the hypertensive disease process during pregnancy as well as self-care procedures. Biometric data (ie, automated blood pressure measurement, qualitative urine protein) were collected at least daily by the patient and transmitted telephonically to a nursing call center. Data were evaluated and subjective symptoms assessed daily. Electronic records were maintained and reports provided to the prescribing physician and case manager. Included for analysis were: patients with pregnancy-related hypertensive conditions receiving outpatient services between January 1999 and November 2003, singleton gestation, no history of chronic hypertension, and gestational age of 20.0-36.9 weeks at start of outpatient program (n = 1,140). Maternal characteristics, antenatal hospitalization and length of stay, progression of disease, and neonatal outcome were analyzed. To evaluate cost-effectiveness, a model was developed to compare the cost of the program plus adjunctive antenatal hospitalization, to control data. The mean gestational age at program start was 32.6 weeks. Antenatal hospital admission was required for 24.8% of patients, with a mean length of stay of 2.3 days per admission. Progression to severe preeclampsia occurred in 14.3% of patients. Mean gestational age at delivery was 37.0 weeks. Antepartum charges averaged 10,327 US dollars per control patient and 4,888 US dollars per program patient, a difference of 5,439 US dollars. For each dollar spent on outpatient management, an average of 2.50 US dollars was saved. Utilizing outpatient management services for women with pregnancy-related hypertension reduces the need for inpatient care and is cost-effective.

The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach

“…An Australian study, comparing urinary protein self-testing by 212 women in clinic, to re-testing by a single nurse, found that self-testing was practical and easily implemented, but did not include an independent reference standard [10]. Several other studies describe providing pregnant women with urine dipsticks to periodically check for protein alongside self-monitoring blood pressure, but have not formally evaluated test performance [11][12][13].…”

The cost-effectiveness of screening for gestational diabetes mellitus in primary and secondary care in the Republic of Ireland

“…NGT, normal glucose tolerance; FDIU, fetal demise in utero incremental estimates provided by the two studies from the USA and Israel [27,28]. Other studies providing nonincremental and, consequently, higher estimates were disregarded [29,30]. The incremental cost of a stillbirth (including fetal demise in utero), compared with that of a live birth, was assessed to be €2,055, based on a study from the UK providing the most comprehensive costing [31].…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…In observational studies, home care has been variably defined in terms of activity levels, self-vs. nurse/midwife assessments, and means of communication; [308,309] all involved daily contact and a (usually) weekly outpatient visit [305,308,309].…”

“…In observational studies of antepartum home care (vs. inpatient care), hospital admission (25%) [309], re-admission (44%) [305] and maternal satisfaction rates [312] were high, with similar outcomes for either gestational hypertension [313], or mild preeclampsia [305]. Costs were lower with home care [309].…”