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A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19

OBJECTIVES: Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop...

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Autores principales: Padula, William V., Miano, Marlea A., Kelley, Marcella A., Crawford, Samuel A., Choy, Bryson H., Hughes, Robert M., Grosso, Riley, Pronovost, Peter J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8536499/
https://www.ncbi.nlm.nih.gov/pubmed/35667779
http://dx.doi.org/10.1016/j.jval.2021.09.008
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author Padula, William V.
Miano, Marlea A.
Kelley, Marcella A.
Crawford, Samuel A.
Choy, Bryson H.
Hughes, Robert M.
Grosso, Riley
Pronovost, Peter J.
author_facet Padula, William V.
Miano, Marlea A.
Kelley, Marcella A.
Crawford, Samuel A.
Choy, Bryson H.
Hughes, Robert M.
Grosso, Riley
Pronovost, Peter J.
author_sort Padula, William V.
collection PubMed
description OBJECTIVES: Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed. METHODS: We analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals’ real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses. RESULTS: Model results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model. CONCLUSIONS: Patient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients’ comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.
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spelling pubmed-85364992021-10-25 A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19 Padula, William V. Miano, Marlea A. Kelley, Marcella A. Crawford, Samuel A. Choy, Bryson H. Hughes, Robert M. Grosso, Riley Pronovost, Peter J. Value Health Themed Section: Remote Patient Monitoring OBJECTIVES: Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed. METHODS: We analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals’ real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses. RESULTS: Model results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model. CONCLUSIONS: Patient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients’ comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts. International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. 2022-06 2021-10-23 /pmc/articles/PMC8536499/ /pubmed/35667779 http://dx.doi.org/10.1016/j.jval.2021.09.008 Text en © 2021 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Themed Section: Remote Patient Monitoring
Padula, William V.
Miano, Marlea A.
Kelley, Marcella A.
Crawford, Samuel A.
Choy, Bryson H.
Hughes, Robert M.
Grosso, Riley
Pronovost, Peter J.
A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19
title A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19
title_full A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19
title_fullStr A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19
title_full_unstemmed A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19
title_short A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19
title_sort cost-utility analysis of remote pulse-oximetry monitoring of patients with covid-19
topic Themed Section: Remote Patient Monitoring
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8536499/
https://www.ncbi.nlm.nih.gov/pubmed/35667779
http://dx.doi.org/10.1016/j.jval.2021.09.008
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