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

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. Participant 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. Trial Registration Pro00113724, exempt Key points Question What is the cost and complexity of replacing pulse oximetry technology to improve disparities, both at a single institution and across the US? Findings In this observational study of pulse oximetry devices in an academic medical system with three hospitals, new and used prices were found for 5,079/5,678 devices (89.5%), with fleet replacement and integration cost of $28.5-31.8 million and some life cycles extending beyond 18 years. When extrapolated to 5,564 hospitals in the United States, estimated replacement costs are $9.7-$20.1 billion. Meaning The monetary and time cost of pulse oximetry hardware replacement is substantial, and solutions utilizing current pulse oximetry technology are essential to delivering equitable care to all patients.