A cost-minimisation population-based analysis of telehealth-integrated antenatal care

In response to the COVID-19 pandemic, Victoria's largest maternity service provider implemented a telehealth-integrated antenatal care (ANC) schedule for high- and low-risk pregnancies. The program has been maintained since March 2020. Given ever-increasing healthcare costs, economic evaluation is crucial to ensure value and guide ongoing use.

The aim of the study was to perform a cost-minimisation analysis of telehealth integrated ANC compared to conventional in-person ANC, from the hospital and patient perspectives. We hypothesised that the costs associated with telehealth integrated ANC would be less than in-person ANC. We generated propensity score matched pre- and post-telehealth cohorts from women with a singleton pregnancy who received ANC and birthed at Monash Health from 1 Jan 2018-22 Mar 2020 (pre-telehealth), and 20 Apr 2020-31 Dec 2021 (post-telehealth). Data were extracted from electronic medical and finance records. We assigned costs for all Monash Health outpatient, inpatient, and emergency department episodes to calculate mean cost per birth. Patient travel costs were estimated based on distance residing from hospital.

Matched pre- and post-telehealth cohorts of n = 13,534 each were created. There were no significant differences in stillbirth, pre-eclampsia, severe maternal morbidity, or death. There was a AU$133 (0.98%, 95% CI [-0.17%, 2.16%]) increase in cost per birth in the post-telehealth cohort. This was driven by increased hospital costs (AU$340 or 2.64% increase, [1.44%, 3.86%]), due to a 4.78% increase in antenatal inpatient episodes and 3.51% increase in outpatient appointments post-telehealth. Increased care complexity was noted in the post-telehealth period with increased rates of gestational diabetes, caesarean birth, and specialty-led care (p-values all <0.0001). In contrast, patient costs of accessing healthcare fell significantly from AU$562 pre-telehealth to AU$355 post-telehealth (difference -AU$207 (-36.81%, [-37.46%, -36.16%]).

Telehealth supported the provision of a greater volume of antenatal care to more complex pregnancies, while maintaining safety and quality of care, for only a minimal cost increase to health funders and substantial cost savings to patients. This finding provides reassurance regarding the financial viability of telehealth-integrated antenatal care.

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