Cost implications of event recordings in apnea/bradycardia home monitoring: a theoretical analysis.

OBJECTIVES

To evaluate the financial impact of incorporating event recordings as an integral component of home apnea/bradycardia monitoring.

STUDY DESIGN

This theoretical analysis examines the cost of home monitoring when medical decisions are based on an evaluation of the cardiorespiratory waveforms surrounding each apnea/bradycardia monitor alarm (documented monitoring) compared to those based on parental observations. Data for both approaches were obtained from 155 infants referred within the first 10 days of life, because a sibling died of sudden infant death syndrome. All were followed on an impedance type apnea/bradycardia monitor with an attached event recorder. The monitor settings were 20 seconds for apnea and 80 beats per minute (bpm) for bradycardia. Parents were taught how to use the equipment, resuscitative techniques, and to complete an alarm log. The clinical protocol provided for home monitoring until there were no "episodes" (prolonged apnea or prolonged bradycardia) for 16 consecutive weeks. A polysomnogram would be obtained if an "episode" occurred. For each infant two independent approaches were used to judge the occurrence of an "episode": (1) parental report of an apnea alarm occurring during sleep or a physiologic alarm associated with skin color change or resuscitative intervention and (2) apnea > or = 20 seconds long or bradycardia > or = 10 seconds. The cost was calculated assuming a 4-week monitor rental fee of $350, a 4-week waveform interpretation fee of $180, and a $600 fee for performing and interpreting a polysomnogram.

RESULTS

Episodes defined from an interpretation of the cardiorespiratory waveforms resulted in fewer diagnostic studies, a shorter period of home monitoring, and lower per patient treatment costs.

CONCLUSION

Despite the increased monthly cost, incorporating event recordings as an integral component of home monitoring resulted in a lower average per patient cost.