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. 2024 Apr;81(4):887-896.
doi: 10.1161/HYPERTENSIONAHA.123.22059. Epub 2024 Jan 23.

Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials

Helen E Campbell  1 , Lucy C Chappell  2 , Richard J McManus  3 , Katherine L Tucker  3 , Carole Crawford  3 , Marcus Green  4 , Oliver Rivero-Arias  1
Affiliations

Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials

Helen E Campbell et al. Hypertension. 2024 Apr.

Abstract

Background: Pregnancy hypertension continues to cause maternal and perinatal morbidity. Two linked UK randomized trials showed adding self-monitoring of blood pressure (SMBP) with automated telemonitoring to usual antenatal care did not result in earlier detection or better control of pregnancy hypertension. This article reports the trials' integrated cost analyses.

Methods: Two cost analyses. SMBP with usual care was compared with usual care alone in pregnant individuals at risk of hypertension (BUMP 1 trial [Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension], n=2441) and with hypertension (BUMP 2 trial, n=850). Clinical notes review identified participant-level antenatal, intrapartum, and postnatal care and these were costed. Comparisons between trial arms used means and 95% CIs. Within BUMP 2, chronic and gestational hypertension cohorts were analyzed separately. Telemonitoring system costs were reported separately.

Results: In BUMP 1, mean (SE) total costs with SMBP and with usual care were £7200 (£323) and £7063 (£245), respectively, mean difference (95% CI), £151 (-£633 to £936). For the BUMP 2 chronic hypertension cohort, corresponding figures were £13 384 (£1230), £12 614 (£1081), mean difference £323 (-£2904 to £3549) and for the gestational hypertension cohort were £11 456 (£901), £11 145 (£959), mean difference £41 (-£2486 to £2567). The per-person cost of telemonitoring was £6 in BUMP 1 and £29 in BUMP 2.

Conclusions: SMBP was not associated with changes in the cost of health care contacts for individuals at risk of, or with, pregnancy hypertension. This is reassuring as SMBP in pregnancy is widely prevalent, particularly because of the COVID-19 pandemic.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334149.

Keywords: blood pressure; cost; hypertension; pregnancy; systolic blood pressure.

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Conflict of interest statement

L.C. Chappell reported serving as Chief Scientific Adviser to the UK Department of Health and Social Care and Chief Executive Officer for the National Institute for Health and Care Research (NIHR) since August 2021. The Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension telemonitoring intervention was developed into a commercial product in collaboration with Sensyne Health and licensed by Oxford University and Sensyne Health for free during the pandemic. The University has received fees subsequently from Sensyne following the conduct of the study. R.J. McManus reported receiving fees from Sensyne following the conduct of the study and nonfinancial support from Omron (Omron licensed and paid consultancy to the University of Oxford with regard to a telemonitoring intervention developed with his help, and previously supplied blood pressure monitors for the TASMINH4 study). R.J. McManus also reported occasional travel and accommodation for speaking at conferences (any honoraria are paid to his institution). The other authors report no conflicts.

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