The High Price of Equity in Pulse Oximetry: A cost evaluation and need for interim solutions

Abstract

Importance: Disparities in pulse oximetry accuracy, disproportionately affecting patients of color, have been associated with serious clinical outcomes. Although many have called for pulse oximetry hardware replacement, the cost associated with this replacement is not known. Objective: To estimate the cost of replacing all pulse oximetry hardware throughout a hospital system. Design: Single-center survey, 2023 Setting: Single center. Participants: One academic medical center with three hospitals. Main Outcomes and Measures: Cost of fleet replacement as identified by current day prices for hardware. Results: New and used prices for 5,079/5,678 (89.5%) across three hospitals for pulse oximetry devices were found. The average equipment cost to replace pulse oximetry hardware is $15,704.12 per bed. Replacement and integration costs are estimated at $28.5-31.8 million for the entire medical system. Extrapolating these costs to 5,564 hospitals in the United States results in an estimated cost of $14.1 billion. Conclusions and Relevance: “Simply replacing” pulse oximetry hardware to address disparities may be neither simple, cheap, or timely. Solutions for addressing pulse oximetry accuracy disparities leveraging current technology may be necessary.

Utility of skin tone on pulse oximetry in critically ill patients: a prospective cohort study

“…Considering the prohibitive cost of replacing existing pulse oximeters, 40 our work stands as a fundamental milestone to any interim solution that may tackle pulse oximetry inaccuracies leveraging existing technologies. If the finding that pulse oximeters are “more consistently wrong” among darker-skinned patients stands in follow-up studies, one could argue that clinical algorithms that perform a holistic correction – and not simple race corrections 41 – could be more attainable, due to the observed lower variance among darker-skinned patients.…”