JMIR Publications

ABSTRACT

Background:

Digital health programs involve substantial implementation costs that are often not fully captured in economic evaluations. For managed care organizations considering coverage of these programs, understanding both implementation costs and cost-effectiveness is essential for informed decision-making.

Objective:

To evaluate the cost-benefit of Electronic Health Record (EHR)-integrated MOMitor™ postpartum monitoring smartphone application versus usual care by comparing 1-year postpartum acute care costs (hospitalizations and emergency department [ED] visits for common postpartum complications) and implementation costs (software, hardware, and labor).

Methods:

We conducted a retrospective cohort study using EHR data from a large quaternary care health system in the southeastern United States. English-speaking women aged ≥18 years, smartphone owners, with ≥1 prenatal visit within 8 weeks pre-delivery, who enrolled in MOMitor™ during delivery hospitalization were included as users. Non-users received usual care. Index date was defined as the day after discharge. Covariates were balanced using inverse probability of treatment weighting (IPTW), with absolute standardized mean differences (ASMDs) <0.1 indicating good balance. One-year postpartum acute care costs were estimated using a two-part model with a gamma distribution and log link. Models were adjusted for baseline acute care costs (8-week pre-delivery) and delivery hospitalization costs. Costs and benefits were monetized to estimate per-patient per-year (PPPY) costs from a healthcare system perspective, adjusted to 2023 USD with 3% annual inflation rate.

Results:

This analysis included 1,679 patients (mean [SD] age 27.0 [5.6] years; 27% Black), with 486 MOMitor™ users and 1,193 non-users. IPTW achieved good covariate balance (ASMDs <0.1) for all covariates. PPPY MOMitor™ implementation costs were $63 for MOMitor™ users only. IPTW-adjusted PPPY postpartum acute care costs were higher among MOMitor™ users ($2,003 vs. $1,151; p=0.61, yielding an incremental acute-care cost of $852 PPPY and a net program cost of $915 PPPY.

Conclusions:

MOMitor™ was not cost-saving during the first postpartum year. Higher acute care costs may partly reflect timely care escalation prompted by app-identified symptoms. Future studies incorporating outpatient costs, maternal morbidity, and quality-adjusted life years are needed. Evaluating MOMitor™ over a longer time horizon would help determine whether its upfront implementation costs are offset by downstream reductions in maternal morbidity and acute-care spending.