International Journal of Technology Assessment in Health Care, 23:2 (2007), 216–222. Copyright c  2007 Cambridge University Press. Printed in the U.S.A. DOI: 10.1017.S0266462307070080 Cost analysis of home monitoring in lung transplant recipients Terrence J. Adam Mayo Clinic Arizona Stanley M. Finkelstein, Stephen T. Parente, Marshall I. Hertz University of Minnesota Objectives: The University of Minnesota has maintained a home monitoring program for over 10 years for lung and heart–lung transplant patients. A cost analysis was completed to assess the impact of home monitoring on the cost of post-transplant medical care. Methods: Clinical information gathered with the monitoring system includes spirometry, vital signs, and symptom data. To estimate the impact of this system on medical costs, we completed a retrospective analysis of the effects of home monitoring on the cost of post-lung transplant medical care. The cost analysis used multivariate linear regression with inpatient, outpatient, and total medical care costs as the dependent variables. The independent variables for the regression include home monitoring adherence, underlying disease, ambulatory diagnostic group mapping variables, transplant type, and patient demographics. Results: The multivariate regression of the overall cost results predicts a 52.4 percent reduction in total costs with 100 percent patient adherence; this rate includes a 72.24 percent reduction in inpatient costs and a 46.6 percent increase in outpatient costs. The actual first year average patient adherence was 74 percent. Conclusions: Adherence to home monitoring increases outpatient costs and reduces inpatient costs and provides an overall cost savings. The break-even point for patient adherence was 25.28 percent, where the net savings covered the cost of home monitoring. This is well within the actual first year adherence rates (74 percent) for subjects in the lung transplant home monitoring program, providing a net savings with adherence to home monitoring. Keywords: Lung transplantation, Home monitoring, Cost analysis Lung transplantation has provided patients with end- stage lung disease a treatment alternative with the op- portunity to improve survival (8;12) and quality of life (10;15;16;21;22;24). Patient survival is reduced by the de- velopment of chronic rejection and infection and provides a significant area of concern for patient follow-up (12). The development of reduced pulmonary function is often an early signal of infection and rejection episodes and provides ad- ditional information beyond normal vital sign and symptom monitoring (4;20). Previous studies have shown that home This research was supported by National Library of Medicine Grant no. T15 LM-07041 (Training in Medical Informatics), NIH Grant no. RO1 NR02128), and the Lung Transplant Program, University of Minnesota. monitoring systems can provide early diagnostic informa- tion regarding infection and rejection episodes and may help prevent long-term transplant dysfunction (28). Home mon- itoring of lung transplant recipients can detect chronic re- jection at an earlier time than normal clinical follow-up (7). However, the cost impact of home monitoring for transplant recipients has not previously been evaluated. Previous stud- ies on the cost-effectiveness of lung transplantation have had variable results with a range of $71,000 to $177,000 per quality adjusted life year (QALY) (1;22;27). These results suggest higher costs than have been estimated for other types of solid organ transplants (10). Home monitoring for lung transplant recipients is a relatively new level of care and thus 216