A cost analysis of home monitoring in post-lung transplantation patients

The University of Minnesota has had active lung transplant home monitoring research since 1992. The research has provided clinical practitioners with supplemental lung function and patient symptom data. This expansion of clinical data has made home monitoring a standard of care with nearly all patients participating. Although clinically useful, the impact of home monitoring on medical cost outcomes has not been established. The expense of home monitoring is a relatively small but nontrivial financial expenditure. In assessing the value of home monitoring, the core question is whether adherence to home monitoring has affected post-transplant medical care costs.; In addressing the question, a retrospective review of insurance claims and patient clinical data was completed. The cost data was analyzed with multivariate linear regression using patient home monitoring adherence as a primary predictor.; The cost regression results show that home monitoring may shift care to the outpatient setting. The corresponding reduction in inpatient costs is larger than the increase in outpatient costs providing a net cost savings.; Evaluation of the regression results provides an estimated savings of {dollar}11,095 for overall medical costs per patient for the first year of patient home monitoring with complete patient adherence. The program has an initial estimated cost of {dollar}2070 per device with additional recurring costs of {dollar}735 per year.; The results of the survival analysis provide some evidence that patient adherence to home monitoring improves survival outcome. The comparison of the study population with patients who did not participate in the study showed a potential survival advantage to home monitored patients (Log rank p = .1080, Wilcoxon p = 0.0297). A comparison of home monitored patients by relative level of adherence (divided into thirds) did not produce a statistically significant survival advantage for higher adherence patients (Log rank p = 0.083, Wilcoxon p = 0.222). However, the patients with the highest one-third adherence had a survival advantage when compared with the lower two-thirds of adherence. (Log rank p = 0.026, Wilcoxon p = 0.085).; The results indicate home monitoring adherence reduces the cost of post-transplant medical care and may produce a survival advantage providing evidence for further use of the technology in the lung transplant patient population.