Economic Analysis Finds Continuous Monitoring for Respiratory Depression May Provide Benefits to Patients and Reduce Hospital Costs


PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY,

PRODIGY, is a Medtronic-sponsored, prospective, observational, multisite study that derived and validated a Risk Prediction Tool. Its purpose is to identify adult patients receiving opioid medication in medical-surgical units who are at increased risk for opioid induced respiratory depression (OIRD), a form of respiratory compromise. Click here to learn more about the primary PRODIGY publication.

46% of patients receiving opioids in the medical-surgical units experience at least one or more episodes of respiratory depression.1

Medtronic offers two key technologies that may be used for continuous respiratory monitoring:

  • Nellcor™ pulse oximetry is indicated for detecting oxygen levels in the blood and measuring pulse rate
  • Microstream™ capnography is indicated for measuring end-tidal CO2, respiratory rate, and apneic episodes

The secondary PRODIGY economics publication concludes that continuous respiratory monitoring has a high chance of being cost-effective3:

  • $535,531 annual hospital costs reduction: Continuously monitoring SpO2 and etCO2 on patients at high risk for respiratory depression is projected to reduce annual hospital costs
  • 103 days saved in cumulative LoS: cumulative patient length of stay is projected to be reduced by 103 days
  • Break-even point at 1.5 percent reduction in respiratory depression: break-even investment point is achieved when reducing respiratory depression by 1.5 percent

A deeper look at the return on investment for adopting continuous respiratory monitoring

For each affected patient:

  • The average hospital cost for U.S. patients with one or more RDEs was significantly higher ($4,426 on average) and the mean cost for “high-risk” scored patients with one or more RDEs was $6,648 higher than for “high-risk” patients without RDEs2
  • Mean hospital length of stay was three days longer in patients with ≥ 1 RDE1

Potential cost savings for the institution ―

for monitoring patients in the high-risk or all-risk categories respectively:†3

  • Projected annual cost savings is between $535,531 to $688,221
  • Reduction in cumulative length of stay would be 103 to 204 days annually
  • Break-even point occurs when respiratory depression is decreased by 1.5–3.5 percent

A 20 percent reduction in patients with ≥ 1 RDE reports:4-6

  • A 34 percent risk reduction for intensive care unit (ICU) transfers
  • Reduction of severe opioid-related adverse events from 3.1/10,000 to 0.6/10,000 patients.
  • A 50 percent decrease in rapid response calls

The numbers at a glance

PRODIGY Risk Category



+ Intermediate

High + Intermediate

+ Low

Median number of patients receiving opioids per hospital annually


Patients in risk group




Length of stay reduction

103 days

152 days

204 days

Avg annual hospital cost savings




Break-even point (percentage points in decreasing respiratory depression)




†This assumes a 20 percent respiratory depression reduction and an annual general care floor volume of 2,447 patients receiving opioids per median-sized hospital. 90% of surgical patients and 45% of medical patients on U.S. general care floors receive opioids. Continuous pulse oximetry and capnography device pricing assumptions used list pricing for the following: a Capnostream™ portable respiratory monitor ($4300) prorated over 7 years; a Microstream™ capnography filterline ($14.50), and a disposable Nellcor™ pulse oximetry sensor ($8.50), resulting in $52.73 in device costs per continuously monitored patient stay on a medical surgical floor. For intermittent pulse oximetry monitoring, device pricing consisted of a multiparameter monitor ($3000) prorated over 7 years and a reusable pulse oximetry sensor ($65), resulting in $0.68 in device costs per patient stay.  Additional information on pricing and assumptions are available in the study publication.

PRODIGY risk prediction tool

The primary objective of the PRODIGY trial was to develop a tool that helps clinicians assess patients at high risk for respiratory depression.  This tool provides an easy-to-use PRODIGY Score, which helps guide clinicians in identifying patients who would benefit most from continuous monitoring including capnography and oximetry in medical-surgical units.

The PRODIGY risk stratification tool may support The Joint Commission’s recent language updates on monitoring postoperative patients receiving opioids as articulated in the Pain Assessment and Management Standards.7  The organization requires hospitals to implement an evidence-based mechanism to identify patients receiving opioids who are at high risk for adverse events.7

To learn more about PRODIGY and/or download the complimentary PRODIGY Risk Assessment Tool, visit

Read the full PRODIGY economics publication in the Advances in Therapy Journal.


1. Khanna AK, Bergese S, Jungquist CR, et al. Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: an international prospective, observational trial. Anesth Analg. Vol. 131(4). October 2020.
2. Saager L, Jiang W, Khanna A, et al. Respiratory depression on general care floors increases cost of care: results from the PRODIGY trial. American Society of Anesthesiologists Abstract Publication 2019.
3. Khanna A, Junquist C, Buhre W, Soto R, di Piazza F, Saager L. Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial. Adv Ther. 2021 May 24:1–15. doi: 10.1007/s12325-021-01779-7.
4. Stites M, Surprise J, McNiel J, Northrop D, De Ruyter M. Continuous Capnography Reduces the Incidence of Opioid-Induced Respiratory Rescue by Hospital Rapid Resuscitation Team. J Patient Saf. 2017.
5. Lam T, Nagappa M, Wong J, Singh M, Wong D, Chung F. Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis. Anesth Analg. 2017;125(6):2019–2029.
6. Steele T, Eidem L, Bond J. Impact of Adoption of Smart Pump System With Continuous Capnography Monitoring on Opioid-Related Adverse Event Rates: Experience From a Tertiary Care Hospital. J Patient Saf. 2019.
7. The Joint Commission. What are the key concepts organizations need to understand regarding the pain management requirements in the Leadership (LD) and Provision of Care, Treatment, and Services (PC) chapters?  January 4 2021.

The Microstream™ capnography and Nellcor™ monitoring systems should not be used as the sole basis for diagnosis or therapy and are intended only as an adjunct in patient assessment.

About the Author

Michael Noble is a Senior Market Strategist for the Medical-Surgical and Procedural Sedation areas of care in the hospital at Medtronic. He develops strategies to help clinicians ensure patient safety with continuous monitoring solutions like Microstream™ capnography, Nellcor™ pulse oximetry, and Vital Sync™ clinical decision support.

Related Content