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 BL, Amberson M, Veit L, Freiberger C, Dukhovny D, Rhein LM. (2017). Economics of Home Monitoring for Apnea in Late Preterm Infants. Senior Scholars Program. https://doi.org/10.4187/respcare.04954. Retrieved from https://escholarship.umassmed.edu/ssp/255