Economic Analysis Finds Continuous Monitoring of Respiratory Depression May Benefit Patients and Reduce Hospital Costs

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The data-driven business model of the PRODIGY trial demonstrates that continuous monitoring of pulse oximetry and capnography of high-risk patients can reduce hospital costs by more $ 500,000 Annually

DUBLIN, July 7, 2021 / PRNewswire / – Medtronic plc (NYSE: MDT), the global leader in medical technology, today announced the release of a business model based on data from the PRODIGY trial (Prediction of Opioid-Induced Respiratory Depression in Patients Monitored by capnoGraphY) which demonstrates shorter patient stays and reduced hospital costs associated with continuous monitoring of pulse oximetry and capnography for patients receiving opioids in medico-surgical units versus intermittent pulse oximetry alone. Continuous capnography and pulse oximetry monitoring of high-risk patients who receive opioids may result in $ 535,531 annual hospital cost savings for a mid-sized US hospital; and a cumulative decrease in patient length of stay of 103 days per year, assuming respiratory depression is reduced by 20%.

Pulse oximetry is a simple, non-invasive bedside technology that can accurately measure changes in arterial blood oxygen saturation and pulse rate. Capnography measures the carbon dioxide exhaled during the respiratory cycle as well as the respiratory rate.

Posted online in May 2021 problem of Advances in therapy, the analysis was based primarily on data from the PRODIGY trial. PRODIGY is a Medtronic-sponsored, multi-center, prospective observational study conducted to quantify the incidence and identify patients at high risk of opioid-induced respiratory depression (OIRD), a potentially fatal form of respiratory compromise (CR) that reduces willpower. patient to breathe.

“Although respiratory depression occurs in 46% of patients receiving opioids in the general care floor, the cost-benefit of capnography and oximetry for continuous patient monitoring has not yet been examined. “, said Ashish K. Khanna, MD, study principal investigator and associate professor of anesthesiology, vice president of research and intensivist at Wake Forest School of Medicine. “Our results suggest that, compared to intermittent monitoring, investing in continuous monitoring of high-risk patients receiving opioids could reduce patient cost and length of stay while potentially increasing patient safety. Our model suggests that a mere 1.5% reduction in the incidence of respiratory depression would allow hospital systems to recoup the costs associated with the investment in surveillance. The expected reduction in the deployment of continuous surveillance on hospital floors is much greater. “

The economic model was designed using a decision tree framework simulating the costs and outcomes of continuous monitoring of Nellcor ™ pulse oximetry and Microstream ™ * capnography versus monitoring of intermittent pulse oximetry * for high-risk, high-risk and intermediate-risk patients, and any risk of respiratory depression based on at their PRODIGY score. The PRODIGY score of the patients was derived from five independent patient characteristics: age, sex, sleep breathing disorders, opioid naivety, and chronic heart failure. The model applied the results of the PRODIGY study to a hypothetical median-sized US hospital with 2,447 patients receiving opioids in a medical-surgical stage in a given year.

“Respiratory impairment is a common, costly, potentially fatal and preventable condition. CR is one of the leading causes of ICU admissions and is one of the main contributing factors to the code blues,1,2” noted Frank chan, president of the Patient Monitoring activity, which is part of Medtronic’s medico-surgical portfolio. “Medtronic has a long history of discovering, developing and commercializing transformative treatment options for patients around the world. As CR continues to be studied, we are able to analyze these learnings and design innovative solutions to help physicians better care for their patients who can experience OIRD. “

In addition, the main objective of the PRODIGY trial was to develop and validate a risk stratification tool to help clinicians identify high risk patients receiving opioids.3 The PRODIGY risk stratification tool can support recent updates from the Joint Commission on the follow-up of postoperative patients receiving opioids with the requirement to put in place a mechanism to identify high-risk patients.4

For more information on the PRODIGY clinical trial, please visit: medtronic.com/prodige.

About respiratory compromise
Respiratory failure is a life-threatening progressive disease that negatively impacts a person’s ability to breathe properly to maintain oxygenation and the elimination of carbon dioxide. Patients with respiratory depression may experience shallow, slow, or no breathing after administration of opioids, which, undetected, can lead to cardiopulmonary arrest and death.5 This condition is quickly becoming the third costliest hospital expense in the United States and dramatically increases the likelihood of adverse patient outcomes and the cost of patient care.6 Not only is respiratory damage common and dangerous, it is very difficult to predict.7,8,9

About the Patient Monitoring Business Unit at Medtronic
Medtronic’s Patient Monitoring business works with the global healthcare community to address clinically significant issues, with technologies and solutions for the management of blood oxygen, respiratory disorders and perioperative complications.

About Medtronic
Medtronic plc (www.medtronic.com), headquartered at Dublin, Ireland, is one of the world’s largest medical technology, services and solutions companies, which relieves pain, restores health and extends the lives of 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 working with stakeholders around the world to advance healthcare, together.

Any forward-looking statement is subject to risks and uncertainties such as those described in Medtronic’s periodic reports filed 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 treatment and are intended only to supplement patient assessment.

* Pricing assumptions for pulse oximetry and continuous capnography machines used list prices for the following: a Capnostream ™ portable respiratory monitor prorated over 7 years; a Microstream ™ capnography filtration line and a disposable Nellcor ™ pulse oximetry sensor, resulting in $ 52.73 in the costs of the device per patient stay continuously monitored in a medical-surgical surgical floor. For intermittent pulse oximetry monitoring, the price of the device consisted of a 7-year pro-rated multi-parameter monitor and a reusable pulse oximetry sensor, which $ 0.68 in device costs per patient stay. Additional information on prices and assumptions is available in the study publication.

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3 Khanna AK, Bergese S, Jungquist CR, et al. Prediction of opioid-induced respiratory depression in inpatient departments 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/00002161/
5 Morris TA, Gay PC, MacIntyre NR, et al. The respiratory compromise as a new paradigm for the management of vulnerable hospitalized patients. Respiratory care. April 2017; 62 (4): 497-512. doi: 10.4187 / respcare.05021.
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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 non-cardiac surgery: a cohort analysis. Anesth Analg. 2016; 123 (6): 1471-9.
8 Khanna AK, Sessler DI, Sun Z, et al. Use of the STOP-BANG questionnaire to predict hypoxemia in patients recovering from non-cardiac surgery: a prospective cohort analysis. British J Anaesth. 2016; 116 (5): 632-40.
9 Sun Z, Sessler DI, Dalton JE et al. Postoperative hypoxemia is frequent and persistent: a prospective blinded observational study. Anesth Analg. 2015; 121 (3): 709-15.

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