Cost-effectiveness of Intermittent vs Continuous Pulse Oximetry Monitoring in Infants Hospitalized With Stabilized Bronchiolitis

Abstract

ImportancePulse oximetry is a noninvasive technology that is integral to the supportive care of hospitalized infants with bronchiolitis. A multicenter, randomized trial comparing the effectiveness of intermittent vs continuous pulse oximetry found similar length of hospital stay and safety outcomes, and greater nursing satisfaction, with intermittent monitoring.ObjectivesTo evaluate the cost-effectiveness of intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis.Design, Setting, and ParticipantsAn economic evaluation concurrent with a randomized trial in community and tertiary children’s hospitals in Ontario, Canada, was conducted using a probabilistic analysis. Patients were enrolled from November 1, 2016, to May 31, 2019. Data included infants aged 4 weeks to 24 months hospitalized with bronchiolitis, with or without supplemental oxygen, after stabilization. The cost-effectiveness analysis adopted a societal and health care system perspective and a time horizon from hospitalization to 15 days post-discharge. Patient level direct health care costs and indirect costs were included. Health resource use, costs, and clinical outcomes were obtained from trial data. Publicly available pricing resources were used to supplement costs. Ranges for sensitivity analysis were based on 95% confidence intervals of the trial data. All costs were reported in 2021 Canadian dollars.InterventionsIntermittent (every 4 hours) vs continuous pulse oximetry using an oxygen saturation target of 90% or higher.Main Outcomes and MeasuresCosts and incremental costs.ResultsTrial data from 229 infants (median [IQR] age, 4.0 [2.2-8.5] months; 136 boys [59.4%], 93 girls [40.6%]) were included. Mean societal costs per patient were $6879 (95% CI, $3393 to $12 317) in the intermittent and $7428 (95% CI, $1743 to $25 011) in the continuous group with a mean incremental cost of −$548 (95% CI, −$18 486 to $8105). Mean health care system costs per patient were $4195 (95% CI, $1191 to $9461) in the intermittent and $4716 (95% CI, $335 to $22 093) in the continuous group (incremental cost, −$520; 95% CI, −$18 286 to $7358). The mean effect measure of length of stay was similar between the 2 groups: 37.4 hours (95% CI, 1.0 to 137.7 hours) in the intermittent group and 38.5 hours (95% CI, 0 to 237.1 hours) in the continuous group. One-way sensitivity analyses on all variables revealed that the findings were robust and the incremental costs were not sensitive to the uncertainty within the defined ranges.Conclusions and RelevanceIn this prospective economic evaluation study, we found that costs were similar for intermittent and continuous pulse oximetry considering societal and health care perspectives. Given that clinical outcomes between monitoring strategies are comparable and that other practice considerations favor intermittent monitoring, these findings provide additional information that support the use of intermittent monitoring in hospitalized infants with stabilized bronchiolitis.

De‐implementing low‐value continuous pulse oximetry practice in infants hospitalized with bronchiolitis: A multicentre qualitative study

“…14 Furthermore, a cost-effectiveness analysis conducted in parallel to our trial found that societal costs were similar between intermittent and continuous monitoring, and there was no increase in caregiver costs postdischarge with less intense monitoring. 16 Given the similar clinical outcomes and other important clinical practice factors such as reducing nursing workload, reducing alarm fatigue, hospital-to-home transition, and simplifying care favor less intense monitoring, findings from randomized clinical trials support intermittent monitoring in stabilized infants hospitalized with bronchiolitis.…”

Weighing the Costs of Pulse Oximetry for Pediatric Bronchiolitis

“…Using continuous pulse oximetry for noncritically ill children hospitalized due to bronchiolitis is often cited as an example given the self-resolving oxygen desaturations that frequently occur in this condition. In this issue of JAMA Network Open , Moretti et al present the results of an economic evaluation for the use of continuous pulse oximetry for children hospitalized with bronchiolitis in 6 Canadian hospitals.…”

“…Anecdotally and in clinical practice, sometimes a number can be easier to react to, and the monitor data can serve as something the health care team can focus on, rather than the less easily described gut feelings and unease about every patient’s uncertain trajectory. The costs of intermittent vs continuous pulse oximetry are relevant to the debate, and the findings from Moretti et al add to that conversation but only paint part of the picture. Likely, the absence of a significant cost difference based on the current study will not tip the balance for those who generally prefer a specific pulse oximetry monitoring strategy.…”