Economic Model Based on PRODIGY Trial Data Demonstrates
Continuous Pulse Oximetry and Capnography Monitoring of High-Risk
Patients May Reduce Hospital Costs by Over $500,000 Annually
DUBLIN, July 7, 2021 /CNW/ -- Medtronic plc
(NYSE:MDT), the global leader in medical technology, today
announced the publication of an economic model based on data from
the PRODIGY trial (PRediction of Opioid-induced respiratory
Depression In patients monitored by capnoGraphY) that demonstrates
shorter patient stays and reduced hospital costs associated with
continuous pulse oximetry and capnography monitoring for patients
receiving opioids on medical-surgical units when compared to
intermittent pulse oximetry alone. According to study findings,
continuous capnography and pulse oximetry monitoring of high-risk
patients who are receiving opioids could result in $535,531 annual hospital cost savings for a
median-sized U.S. hospital and a cumulative patient length of stay
decrease of 103 days per year, assuming respiratory depression is
decreased by 20%.
Pulse oximetry is a simple, noninvasive bedside technology that
can accurately measure changes in arterial blood oxygen saturation
and pulse rate. Capnography measures exhaled carbon dioxide during
the respiration cycle as well as respiratory rate.
Published online in the May 2021
issue of Advances in Therapy, the analysis was
based primarily on data from the PRODIGY trial. PRODIGY is a
Medtronic-sponsored, prospective observational, multi-center study
conducted to quantify the incidence of and identify patients at
high risk for opioid-induced respiratory depression (OIRD), a
potentially life-threatening form of respiratory compromise (RC)
that reduces the patient's drive to breathe.
"Although respiratory depression occurs in 46% of patients
receiving opioids on the general care floor, the cost-benefit of
capnography and oximetry for continuous monitoring of patients had
not yet been examined," said Ashish K.
Khanna, M.D., primary study investigator and an associate
professor of Anesthesiology, vice-chair for Research, and
intensivist at the Wake Forest School of Medicine. "Our findings
suggest that compared to intermittent monitoring, investing in
continuous monitoring of high-risk patients receiving opioids could
reduce the cost burden and length of patient stay while potentially
increasing patient safety. Our model suggests that a mere reduction
of 1.5% in the incidence of respiratory depression would allow
hospital systems to recover costs associated with the investment in
monitoring. The expected reduction from deployment of continuous
monitoring on hospital floors is way more."
The economic model was designed using a decision tree framework
simulating costs and outcomes of continuous Nellcor™ pulse oximetry
and Microstream™ capnography monitoring* versus intermittent pulse
oximetry monitoring* for patients at high risk, high and
intermediate risk, and any risk of respiratory depression based on
their PRODIGY score. Patients' PRODIGY score was derived from five
independent patient characteristics — age, gender, sleep-disordered
breathing, opioid naivety, and chronic heart failure. The model
applied the results of the PRODIGY study to a hypothetical
median-sized U.S. hospital with 2,447 patients receiving opioids on
a medical surgical floor in a given year.
"Respiratory compromise is a common, costly, potentially deadly
— and preventable — condition. RC is a leading cause of ICU
admissions and is one of the key contributing factors for code
blues,1,2" said Frank Chan, president of the Patient Monitoring
business, which is part of the Medical Surgical Portfolio at
Medtronic. "Medtronic has a deep-rooted history of discovering,
developing, and commercializing transformative treatment options
for patients globally. As RC continues to be studied, we are able
to analyze these learnings and design innovative solutions to help
physicians better care for their patients who may experience
OIRD."
Additionally, the primary objective of the PRODIGY trial was to
develop and validate a risk stratification tool to assist
clinicians in the identification of high risk patients receiving
opioids.3 The PRODIGY risk stratification tool may
support the recent updates from The Joint Commission on monitoring
of post-operative patients receiving opioids with the requirement
of putting in place a mechanism to identify high risk
patients.4
For additional information about the PRODIGY clinical trial,
please visit: medtronic.com/prodigy.
About Respiratory Compromise
Respiratory compromise is
a potentially life-threatening, progressive condition negatively
impacting a person's ability to breathe adequately to maintain
oxygenation and carbon dioxide removal. Patients with respiratory
depression may experience shallow, slow, or no breathing after
opioid administration which undetected can lead to cardiopulmonary
arrest and death.5 This condition is rapidly
becoming the third-most costly hospital inpatient expense in the
U.S., and dramatically increases the likelihood of adverse patient
outcomes and cost of patient care.6 Not only is
respiratory compromise common and dangerous, it has been very
difficult to
predict.7,8,9
About the Patient Monitoring Operating Unit at
Medtronic
The Patient Monitoring business at Medtronic is working together
with the global healthcare community to solve clinically meaningful
problems, with technologies and solutions for blood oxygen
management, respiratory compromise, and perioperative
complications.
About Medtronic
Medtronic plc (www.medtronic.com),
headquartered in Dublin, Ireland,
is among the world's largest medical technology, services, and
solutions companies – alleviating pain, restoring health, and
extending life for millions of people around the world. Medtronic
employs more than 90,000 people worldwide, serving physicians,
hospitals, and patients in more than 150 countries. The company is
focused on collaborating with stakeholders around the world to take
healthcare Further, Together.
Any forward-looking statements are subject to risks and
uncertainties such as those described in Medtronic's periodic
reports on file with the Securities and Exchange Commission. Actual
results may differ materially from anticipated results.
Pulse oximetry and capnography monitoring systems should not
be used as the sole basis for diagnosis or therapy and are intended
only as an adjunct in patient assessment.
* Continuous pulse oximetry and capnography device pricing
assumptions used list pricing for the following: a Capnostream™
portable respiratory monitor prorated over 7 years; a Microstream™
capnography filterline, and a disposable Nellcor™ pulse oximetry
sensor, resulting in $52.73 in device
costs per continuously monitored patient stay on a medical surgical
floor. For intermittent pulse oximetry monitoring, device pricing
consisted of a multiparameter monitor prorated over 7 years and a
reusable pulse oximetry sensor, resulting in $0.68 in device costs per patient stay.
Additional information on pricing and assumptions are available in
the study publication.
1 Schein RM, Hazday N, Pena M, Ruben BH, Sprung
CL. Clinical antecedents to in-hospital cardiopulmonary arrest.
Chest. 1990; 98(6):1388–1392.
2 Fecho K, Jackson F, Smith F, OverdykF.
In-hospital resuscitation: opioids and other factors influencing
survival. Ther Clin Risk Manag.
2009;5:961–968.
3 Khanna AK, Bergese S, Jungquist CR, et al.
Prediction of opioid-induced respiratory depression on inpatient
wards using continuous capnography and oximetry: an international
prospective, observational trial. Anesth Analg.
2020;131:1012-1024.
4 https://www.jointcommission.org/standards/standard-faqs/hospital-and-hospital-clinics/leadership-ld/000002161/
5 Morris TA, Gay PC, MacIntyre NR, et al.
Respiratory compromise as a new paradigm for the care of vulnerable
hospitalized patients. Respir Care. 2017 Apr;62(4):497-512. doi:
10.4187/respcare.05021.
6 Wier LM, Henke R, Friedman B. Diagnostic groups
with rapidly iCosts, by payer, 2001-2007: statistical brief #91.
Healthcare Cost and Utilization Project (HCUP) Statistical Briefs.
Rockville MD; June 2010.
7 Belcher AW, Khanna AK, Leung S, et al.
Long-acting patient-controlled opioids are not associated with more
postoperative hypoxemia than short-acting patient-controlled
opioids after noncardiac surgery: a cohort analysis. Anesth Analg.
2016;123(6):1471-9.
8 Khanna AK, Sessler DI, Sun Z, et al. Using the
STOP-BANG questionnaire to predict hypoxaemia in patients
recovering from noncardiac surgery: a prospective cohort analysis.
Brit J Anaesth. 2016;116(5):632-40.
9 Sun Z, Sessler DI, Dalton JE, et al.
Postoperative hypoxemia is common and persistent: a prospective
blinded observational study. Anesth Analg. 2015;121(3):709-15.
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