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 follow-up. We recommend adoption of this technology across health systems to cost-effectively manage COVID19 volume surges, maintain patients’ comfort, reduce infection spread, and simultaneously monitor multiple patients.