Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA; Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Value Health. 2022 Jun;25(6):890-896. doi: 10.1016/j.jval.2021.09.008. Epub 2021 Oct 23.
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.
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.
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.
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.
自 2020 年以来，COVID-19 已在美国感染数千万人，并导致数十万人死亡。感染浪潮导致需要呼吸窘迫的患者急诊就诊和重症监护入院增加。尽管许多人出现了需要呼吸机的症状，但一些 COVID-19 患者可以留在家里，以减轻医院过度拥挤的状况。对患有 COVID-19 的病情中等的患者进行远程脉搏血氧仪（脉搏血氧）监测，可用于监测症状恶化并根据需要触发就诊。
我们从美国医疗保健部门的角度，使用具有 3 周时间范围和每日循环的 Markov 模型来分析远程脉搏血氧监测的成本效益。成本（2020 年美元）和结果来自大学医院的真实世界证据和已发表的文献。成本和质量调整生命年（QALY）用于确定在每 QALY 成本效益阈值为 10 万美元的情况下的增量成本效益比。我们使用单变量和概率敏感性分析评估模型不确定性。
模型结果表明，通过降低成本（节省 11472 美元）和改善结果（增加 0.013 QALY），远程监测优于当前的标准护理。接受远程脉搏血氧监测的患者住院次数减少了 87%，死亡人数减少了 77%。在模型不确定性范围内，增量成本效益比不敏感。
COVID-19 患者的远程脉搏血氧监测增加了需要后续治疗以应对症状恶化的患者的特异性。我们建议在整个医疗系统中采用远程监测，以经济地管理 COVID-19 病例激增，维持患者的舒适度，减少社区感染的传播，并由经过培训的专家从一个地点仔细监测多个患者的需求。
