Cost-effectiveness strategies in OSAS management: a short review

Abstract

L’apnea ostruttiva del sonno (OSAS) è una malattia cronica eccessivamente sotto-diagnosticata con un’alta prevalenza negli adulti. L’OSAS sta diventando un problema sociale significativo perché associata ad un peggioramento della qualità della vita ed un aumento della mortalità. Il rapporto costo-efficacia nella gestione diagnostica e terapeutica dell’OSAS è un problema strategico per contrastare la crescente domanda di test oggettivi. I pazienti OSAS che non presentano comorbilità clinicamente evidenti devono essere studiati utilizzando un sistema semplificato e poco costoso, come l’Home Sleep Testing (HST). Al contrario, la Sleep Laboratory Polisomnography (PSG) rimane il gold standard per la gestione dei pazienti con OSAS in presenza di comorbidità. Occorre sottolineare che l’uso di HST potrebbe portare ad una diagnosi errata in soggetti OSAS non ben selezionati. Questa breve rassegna si propone di offrire argomenti di riflessione sulla corretta diagnosi e trattamento dell’OSAS, in rapporto ai dati di prevalenza e alle ricadute sui costi/benefici sociali della malattia. Attualmente non può essere solo il rapporto costo/efficacia a definire il modello organizzativo adottato per la gestione dell’OSAS, in quanto si rendono necessari ulteriori studi prospettici a lungo termine, volti a validare in maniera definitiva tale rapporto nonché il confronto tra il trattamento con modelli di gestione ospedaliera versus l’assistenza domiciliare.

Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study

“…The gold standard for the diagnosis of OSAS still remain polysomnography [ 9 ], even if other alternatives have also been studied such as a home sleep apnea test (HST) with pulse-oximetry. In fact, even if some alternative tests such as the HST could be considered a cost-effective solution for the diagnosis of OSAS, it has been demonstrated that they are not recommended for the definitive diagnosis of this syndrome [ 40 , 41 ]. On the other hand, it should be noted that polysomnography is very expensive and must be performed for at least two nights in a row.…”

Cross Sectional Study of the Community Self-Reported Risk of Obstructive Sleep Apnoea (OSA) and Awareness in Thessaly, Greece

“…OSAS is an underdiagnosed chronic disease. Untreated patients are at a significantly increased risk of developing cardiovascular, metabolic and neurocognitive diseases, as well as motor vehicle (MVAs) and/or work accidents [ 6 ]. Additionally, OSA is strongly associated with inflammation disorders and, interestingly, with allergic and vasomotor rhinitis [ 7 ].…”

Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea: a systematic review protocol

“…Robust evidence about the potential economic benefit of OSA diagnostic testing is required to guide decisionmakers towards better allocation of scarce healthcare resources. Only a few studies have sought to investigate the health economic impact of OSA diagnostic studies [58,59]. One previous literature review included nine studies, predominantly examining the cost of diagnostic testing [58].…”

“…One previous literature review included nine studies, predominantly examining the cost of diagnostic testing [58]. In contrast, the most recent review has focused on constructing a cost-effectiveness model of OSA management based on existing data [59]. However, none have thoroughly examined the evidence related to the cost and effectiveness of limited channel testing compared to PSG.…”