PT  - JOURNAL ARTICLE
AU  - Brian L Montenegro
AU  - Michael Amberson
AU  - Lauren Veit
AU  - Christina Freiberger
AU  - Dmitry Dukhovny
AU  - Lawrence M Rhein
TI  - Economics of Home Monitoring for Apnea in Late Preterm Infants
AID  - 10.4187/respcare.04954
DP  - 2017 Jan 01
TA  - Respiratory Care
PG  - 42--48
VI  - 62
IP  - 1
4099  - http://rc.rcjournal.com/content/62/1/42.short
4100  - http://rc.rcjournal.com/content/62/1/42.full
AB  - 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.