Economics of Home Monitoring for Apnea in Late Preterm Infants
Department of Pediatrics; School of Medicine; Senior Scholars Program
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Medical Education | Pediatrics
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.
apnea, bradycardia, cost, desaturation, home monitor, late preterm
DOI of Published Version
Respir Care. 2017 Jan;62(1):42-48. doi: 10.4187/respcare.04954. Link to article on publisher's site
Montenegro, Brian L.; Amberson, Michael; Veit, Lauren; Freiberger, Christina; Dukhovny, Dmitry; and Rhein, Lawrence M., "Economics of Home Monitoring for Apnea in Late Preterm Infants" (2017). University of Massachusetts Medical School. Senior Scholars Program. Paper 255.