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 journalArticlepeer-review

8 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 pre- term 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
StatePublished - Jan 2017

Keywords

  • Apnea
  • Bradycardia
  • Cost
  • Desaturation
  • Home monitor
  • Late preterm

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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