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- Title
Economics of Home Monitoring for Apnea in Late Preterm Infants.
- Authors
Montenegro, Brian L.; Amberson, Michael; Veit, Lauren; Freiberger, Christina; Dukhovny, Dmitry; Rhein, Lawrence M.
- 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. Outpatient 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.
- Subjects
MASSACHUSETTS; APNEA treatment; BRADYCARDIA treatment; HOME care services; NEONATAL intensive care; PULSE oximeters; ACADEMIC medical centers; ACTIVE oxygen in the body; CAFFEINE; COMPARATIVE studies; COST control; COST effectiveness; PREMATURE infants; OXIMETRY; PATIENT monitoring; NEONATAL intensive care units; DISCHARGE planning; CONTINUING education units; PATIENT readmissions; DESCRIPTIVE statistics; CHILDREN; ECONOMICS
- Publication
Respiratory Care, 2017, Vol 62, Issue 1, p42
- ISSN
0020-1324
- Publication type
Article
- DOI
10.4187/respcare.04954