Economics of Home Monitoring for Apnea in Late Preterm Infants

Brian L. Montenegro, Michael Amberson, Lauren Veit, Christina Freiberger, Dmitry Dukhovny, Lawrence M. Rhein

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

BACKGROUND: Apnea of prematurity affects a small proportion but large absolute number of late preterm infants, with out-patient management variably utilized despite relative clinical equipoise and potential for improved cost-effectiveness.

METHODS: Over a 5-y period, from 2009 to 2013, infants born at ≥34 weeks gestational age at a level IIIB academic center in Boston, Massachusetts, with discharge-delaying apnea, bradycardia, and desaturation (ABD) events were identified. In-patient costs for discharge-delaying ABD events were compared with hypothetical out-patient management. Out-patient costs took into account 4-10 d of in-patient observation for ABD events before caffeine initiation, 3-5 d of additional in-patient observation before discharge, daily caffeine until 43 weeks corrected gestational age, home pulse oximetry monitoring until 44 weeks corrected gestational age, and consideration of variable readmission rates ranging from 0 to 10%.

RESULTS: A total of 425 late preterm and term infants were included in our analysis. Utilization of hypothetical out-patient management resulted in cost savings per eligible patient ranging from $2,422 to $62, dependent upon variable periods of in-patient observation. Sensitivity analysis demonstrated few instances of decreased relative cost-effectiveness.

CONCLUSIONS: Out-patient management of discharge-delaying ABD events in a late preterm and term population was a cost-effective alternative to prolonged in-patient observation.

Original languageEnglish (US)
Pages (from-to)42-48
Number of pages7
JournalRespiratory Care
Volume62
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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Keywords

  • apnea
  • bradycardia
  • cost
  • desaturation
  • home monitor
  • late preterm

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Montenegro, B. L., Amberson, M., Veit, L., Freiberger, C., Dukhovny, D., & Rhein, L. M. (2017). Economics of Home Monitoring for Apnea in Late Preterm Infants. Respiratory Care, 62(1), 42-48. https://doi.org/10.4187/respcare.04954