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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Objectives: As of December 2020, COVID19 has infected over 13 million Americans and killed over 275,000. Each infection surge leads to increased emergency department (ED) utilization and subsequent critical care admission for patients with acute respiratory distress syndrome (ARDS). Not all COVID19 patients necessitate a ventilator and therefore can remain at home to minimize infection spread and manage hospital capacity concerns. Remote Bluetooth-enabled pulse-oximeter monitoring of moderate-to-severely ill COVID19 patients can be used to closely monitor symptoms and trigger necessary visits to the hospital. Our objective was to analyze remote pulse-oximeter monitoring cost-effectiveness to reduce facility burden and health expenditures. Methods: We analyzed home-monitoring with pulse-oximetry cost-utility using a Markov model over a 3-week time horizon in daily cycles from a US health sector perspective. Cost and outcome measures were derived from real-world evidence from University Hospitals. Pulse-oximetry monitoring was implemented for patients presenting at the ED with ARDS-like symptoms but not necessitating immediate care; patients were then remotely monitored by experts for up to 4-days until recovery or a second ED visit. Additional parameters were extracted from literature. Costs (2020 U.S. dollars) and quality-adjusted life years (QALYs) were used to determine the incremental cost-effectiveness ratio (ICER) at a $100,000/QALY cost-effectiveness threshold. Model uncertainty was assessed using one-way and probabilistic sensitivity analysis. Results: Results demonstrated that pulse-oximetry monitoring dominated current standard care for COVID19 patients based on reduced costs and increased QALYs. Individuals with access to remote pulse-oximetry monitoring averaged $49,176 and 0.03 QALYs, whereas standard care increased costs to $113,792 and 0.02 QALYs. Resulting ICER was not sensitive to uncertainty ranges. Conclusions: Remote pulse-oximetry monitoring of symptomatic COVID19 patients increases the specificity of those requiring immediate followup. We recommend adoption of this technology across health systems to costeffectively manage COVID19 volume surges, maintain patients' comfort, reduce infection spread, and simultaneously monitor multiple patients.