title: Economics of Home Monitoring for Apnea in Late Preterm Infants.
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. 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.
authors.affiliation: Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Montenegro
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Amberson
authors.affiliation: Division of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Lauren
authors.initials: L
authors.lastname: Veit
authors.affiliation: Boston College, Chestnut Hill, Massachusetts.
authors.forename: Christina
authors.initials: C
authors.lastname: Freiberger
authors.affiliation: Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Dukhovny
authors.affiliation: Department of Pediatrics, UMass Memorial Children's Medical Center, Worcester, Massachusetts. Lawrence.Rhein@umassmemorial.org.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Rhein
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D001049:Apnea / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D001919:Bradycardia / Q000191:economics / Q000628:therapy; D002110:Caffeine / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D017046:Cost Savings; D005865:Gestational Age; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007902:Length of Stay / Q000191:economics*; D018670:Monitoring, Ambulatory / Q000191:economics*; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010359:Patient Readmission / Q000191:economics
chemical_list: D000697:Central Nervous System Stimulants; D002110:Caffeine; D010100:Oxygen
keywords: apnea; bradycardia; cost; desaturation; home monitor; late preterm