Cost‐minimisation analysis of polysomnography and pulse oximetry in a risk stratification protocol for paediatric adenotonsillectomy

Abstract

Background: Severe obstructive sleep apnoea (OSA) is associated with increased risk of respiratory compromise in the post-operative period following adenotonsillectomy (AT). This study analyses the economic cost of polysomnography or overnight oximetry as part of pre-operative risk stratification in paediatric AT, supplementing previously published research demonstrating the efficacy of this protocol in predicting respiratory complications. Methods: This cost-minimisation analysis examines costs associated with pre-operative overnight oximetry and polysomnography in triaging paediatric patients older than 2 years old, with no major comorbidities except for OSA, undergoing AT for OSA (n = 1801) to either a secondary or quaternary Australian hospital. Decision analysis modelling via probability trees were utilized to estimate pre-and peri-operative costs. A third hypothetical 'no investigation' model based upon conducting all AT at a secondary hospital was performed. Costs are derived from the financial year 2020-2021, censored at discharge. Results: The total cost per patient of AT including pre-operative investigations of oximetry and polysomnography, and associated inpatient costs, were AUD4181.34 and 5013.99 respectively. This is more expensive compared to a hypothetical no-investigation model (AUD3958.98). Conclusion: Within the scope of this partial economic evaluation, this study finds a small additional cost for a model of care involving overnight oximetry as a pre-operative triage tool, balanced by the reduced cost of care in a lower acuity centre for low-risk patients and potential high cost of complications if all children are treated in a low acuity centre. This supports oximetry in peri-operative risk stratification for paediatric AT from a financial perspective.

Drive‐through delivery of home overnight oximetry

“…It should be noted that oximetry is not a substitute for polysomnography for the diagnosis of obstructive sleep apnoea due to its negative predictive value, rather a triage tool with potential to prioritize access to the scarce resources of both polysomnography and surgical treatment, 1 with attendant cost savings and improvement in care. 2,5 The analysis presented speaks to the utility of a simplified delivery model for oximetry used in this way. We recommend this mode of delivery for routine care and plan to continue T A B L E 1 Comparison of demographic factors and failure rates between home oximetry tests conducted using the two models: face-to-face and drive-through.…”