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Poster Session 1

Category: Hypertension

Poster Session 1

(170) Very tight (<130/80mmHg) postpartum blood pressure control for hypertensive disorders of pregnancy: A cost-effectiveness analysis

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Clarice G. Zhou, MD (she/her/hers)

Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
NYU Grossman School of Medicine, New York, United States

Coauthor(s)

Amelia H. Gagliuso, BA (she/her/hers)

Medical Student
Oregon Health and Science University
Portland, Oregon, United States
LB

Lily Ben-Avi, BA

Oregon Health & Science University
Oregon Health & Science University, Oregon, United States
Aaron B. Caughey, MD, PhD

Chair and Professor of Obstetrics and Gynecology
Oregon Health & Science University
Oregon Health & Science University, Oregon, United States
Justin S. Brandt, MD (he/him/his)

Associate Professor, Division Director, Fellowship Program Director
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York, New York, United States
RB

R. Scott Braithwaite, MD

NYU Grossman School of Medicine
NYU Grossman School of Medicine, New York, United States
Christina A. Penfield, MD, MPH

Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
New York City, New York, United States

Objective:
Very tight blood pressure (BP) control < 130/80mmHg with postpartum remote patient monitoring (RPM) decreases emergency department (ED) visits and improves hypertensive disorders of pregnancy (HDP) complications. However, whether benefits outweigh the increased visits and costs to the healthcare system is less clear. Our objective was to determine whether a policy of very tight postpartum BP control using RPM for HDP was cost-effective compared to standard care.

Study Design:
A cost-effectiveness model was constructed to compare very tight BP < 130/80mmHg with RPM to standard care for patients with HDP until 6 weeks postpartum. The model considered number of postpartum and primary care visits, ED visits, readmission, neurological complications, acute kidney injury (AKI), and maternal death. The primary outcomes were total cost and quality-adjusted life years (QALYs). Probabilities, utilities, and costs were derived from published literature. Costs were expressed in 2025 US dollars with a willingness to pay threshold (WTP) set at $100,000/QALY. Sensitivity analyses were performed to interrogate model assumptions.

Results:
In our theoretical cohort of 472,000 patients with HDP, very tight BP led to 23,467 more postpartum and 11,946 more primary care visits but resulted in 22,507 fewer ED visits and 1,599 fewer hospital readmissions. Tight BP control also led to 17 fewer neurological complications and AKI in the theoretical cohort. A policy of very tight postpartum BP control and RPM led to a net benefit of 37 QALYs for the cohort compared to standard care, but increased healthcare costs by $67 million, suggesting an ICER of $1.8 million, which exceeds the WTP threshold. With sensitivity analysis, when program cost per patient for RPM exceeded $82, standard care remains cost-effective.

Conclusion:
While a policy of very tight BP < 130/80mmHg and RPM reduced the rate of hospital readmissions and HDP-related complications, it is not cost-effective. Before widespread implementation, strategies to minimize the economic impact of this policy, while maintaining patient-centered outcomes, may be beneficial.