Demonstrated Cost-effectiveness of a Telehomecare Program for Gestational Diabetes Mellitus Management.

BACKGROUND Prevalence of gestational diabetes mellitus (GDM) has increased steadily in recent years. Pregnant women with GDM are at risk for obstetrical and neonatal complications and require close multidisciplinary follow-up, which implies a significant use of hospital resources. METHODS A prospective noninferiority and controlled clinical trial was designed. The telehomecare (THCa) initiative is a clinical remote patient management project in women with GDM. The main objective was to evaluate the cost-effectiveness of THCa by assessing the directs costs including the related reduction in medical visits. Secondary outcomes were to evaluate the impact of THCa on diabetes control, GDM-related complications and patient satisfaction. RESULTS A total of 161 women were assigned to either an intervention group provided with a THCa system for transmission and online analysis of capillary glucose data (n=80) or a control group receiving usual care in the clinic (n=81). A decrease in medical visits by 56% (p<0.001) in the THCa group was observed. There was no difference between the two groups in diabetes control or maternal and fetal complications. However, results showed a 10-fold increase in nursing interventions in THCa group (mainly by phone calls and emails). Satisfaction with care was high. Direct cost analysis revealed a savings of 16% in patients followed by THCa as compared with the control group. CONCLUSION THCa monitoring significantly decreases medical visits and direct costs in GDM women without compromising pregnancy outcomes, quality of care, or patient satisfaction. THCa was shown to be cost-effective despite placing an additional burden on nursing time.