Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial

Ashish K Khanna, Carla R Jungquist, Wolfgang Buhre, Roy Soto, Fabio Di Piazza, Leif Saager, PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Investigators, Sergio D Bergese, Hiroshi Morimatsu, Shoichi Uezono, Simon Lee, Lian Kah Ti, Richard D Urman, Robert McIntyre Jr, Carlos Tornero, Albert Dahan, Toby N Weingarten, Maria Wittmann, Dennis Auckley, Luca Brazzi, Morgan Le Guen, Frank Schramm, Frank J Overdyk, Ashish K Khanna, Carla R Jungquist, Wolfgang Buhre, Roy Soto, Fabio Di Piazza, Leif Saager, PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Investigators, Sergio D Bergese, Hiroshi Morimatsu, Shoichi Uezono, Simon Lee, Lian Kah Ti, Richard D Urman, Robert McIntyre Jr, Carlos Tornero, Albert Dahan, Toby N Weingarten, Maria Wittmann, Dennis Auckley, Luca Brazzi, Morgan Le Guen, Frank Schramm, Frank J Overdyk

Abstract

Introduction: Despite the high incidence of respiratory depression on the general care floor and evidence that continuous monitoring improves patient outcomes, the cost-benefit of continuous pulse oximetry and capnography monitoring of general care floor patients remains unknown. This study modeled the cost and length of stay savings, investment break-even point, and likelihood of cost savings for continuous pulse oximetry and capnography monitoring of general care floor patients at risk for respiratory depression.

Methods: A decision tree model was created to compare intermittent pulse oximetry versus continuous pulse oximetry and capnography monitoring. The model utilized costs and outcomes from the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial, and was applied to a modeled cohort of 2447 patients receiving opioids per median-sized United States general care floor annually.

Results: Continuous pulse oximetry and capnography monitoring of high-risk patients is projected to reduce annual hospital cost by $535,531 and cumulative patient length of stay by 103 days. A 1.5% reduction in respiratory depression would achieve a break-even investment point and justify the investment cost. The probability of cost saving is ≥ 80% if respiratory depression is decreased by ≥ 17%. Expansion of continuous monitoring to high- and intermediate-risk patients, or to all patients, is projected to reach a break-even point when respiratory depression is reduced by 2.5% and 3.5%, respectively, with a ≥ 80% probability of cost savings when respiratory depression decreases by ≥ 27% and ≥ 31%, respectively.

Conclusion: Compared to intermittent pulse oximetry, continuous pulse oximetry and capnography monitoring of general care floor patients receiving opioids has a high chance of being cost-effective.

Trial registration: www.clinicaltrials.gov , Registration ID: NCT02811302.

Keywords: Break-even analysis; Capnography; Continuous monitoring; Cost savings; Economic model; General care floor; Healthcare economics; Pulse oximetry; Respiratory compromise; Respiratory depression.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Model framework, distinguishing between total annual hospital cost for a standard of care intermittent pulse oximetry monitoring and b implementation of continuous pulse oximetry and capnography monitoring based on patient PRODIGY score
Fig. 2
Fig. 2
a Annual cost savings (US dollars) and b length of stay reduction predicted following implementation of continuous pulse oximetry and capnography monitoring on patients with high (blue line), high or intermediate (red line), or high, intermediate, or low (green line) risk for respiratory depression. Model was derived the on basis of the US PRODIGY cohort with cost data available, including outliers
Fig. 3
Fig. 3
Probability of cost savings following implementation of continuous pulse oximetry and capnography monitoring on patients with high (blue line), high or intermediate (red line), or high, intermediate, or low (green line) risk for respiratory depression. Model was derived on the basis of the US PRODIGY cohort with cost data available, including outliers

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Source: PubMed

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