Mendlowitz Andrew B, Widjaja Elysa, Phan Cathy, Sun Zhuolu, Moretti Myla E, Schuh Suzanne, Coyte Peter C, Hancock-Howard Rebecca, Freedman Stephen B, Ungar Wendy J
From the Institute of Health Policy, Management & Evaluation, University of Toronto.
Department of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario.
Pediatr Emerg Care. 2021 Aug 1;37(8):e443-e448. doi: 10.1097/PEC.0000000000001664.
A previous randomized controlled trial showed that artificially elevating the pulse oximetry display resulted in fewer hospitalizations with no worse outcomes. This suggests that management decisions based mainly on pulse oximetry may unnecessarily increase health care costs. This study assessed the incremental cost of altered relative to true oximetry in infants with mild to moderate bronchiolitis.
A cost analysis was undertaken from the health care system and societal perspectives using patient-level data from the randomized controlled trial, with a 5-day time horizon after emergency department visit. Infants aged 4 weeks to 12 months with mild to moderate bronchiolitis were randomized to pulse oximetry measurements with true or altered saturation values displayed by artificially increasing saturation 3% points above true values. Direct and indirect health care costs were measured. Sensitivity analyses were performed to assess parameter uncertainty.
From the health care system perspective, the average cost per patient was Can $1155 for altered oximetry and $1967 for true oximetry, with a net savings of $812. From a societal perspective, the average cost per patient was $1559 for altered oximetry and $2473 for true oximetry, with a net savings of $914. Probabilistic analyses demonstrated that altered oximetry remained the less costly study group, with an average savings of $810 (95% confidence interval, $748-$872) from the health care system perspective and $910 (95% confidence interval, $848-$973) from the societal system perspective.
Reliance on oximetry as a major determinant in the decision to hospitalize infants with mild to moderate bronchiolitis is associated with significantly greater costs.
先前一项随机对照试验表明，人为提高脉搏血氧饱和度显示值可减少住院次数，且不会导致更差的结果。这表明主要基于脉搏血氧饱和度的管理决策可能会不必要地增加医疗成本。本研究评估了轻度至中度细支气管炎婴儿中，相对于真实血氧饱和度而言，改变后的血氧饱和度的增量成本。
利用随机对照试验的患者层面数据，从医疗保健系统和社会角度进行成本分析，时间范围为急诊就诊后的5天。年龄在4周至12个月的轻度至中度细支气管炎婴儿被随机分为两组，一组显示真实的血氧饱和度测量值，另一组通过将饱和度人为提高3个百分点高于真实值来显示改变后的饱和度值。测量直接和间接医疗保健成本。进行敏感性分析以评估参数不确定性。
从医疗保健系统角度来看，改变后的血氧饱和度组每位患者的平均成本为1155加元，真实血氧饱和度组为1967加元，净节省812加元。从社会角度来看，改变后的血氧饱和度组每位患者的平均成本为1559加元，真实血氧饱和度组为2473加元，净节省914加元。概率分析表明，改变后的血氧饱和度组仍然是成本较低的研究组，从医疗保健系统角度平均节省810加元（95%置信区间，748 - 872加元），从社会系统角度平均节省910加元（95%置信区间，848 - 973加元）。
将血氧饱和度作为决定轻度至中度细支气管炎婴儿是否住院的主要决定因素会导致成本显著增加。
