Home- vs. Laboratory-Based Management Of OSA: An Economic Review

Abstract

Obstructive sleep apnea (OSA) is a common condition that impairs quality of life and health. Diagnosis and treatment of OSA is cost-effective; however, the economics of various management strategies remain to be defined. Home sleep apnea tests (HSAT) provide an alternative to laboratory based polysomnography (PSG) and are less expensive than PSG on a per test basis; however, when utilized within a framework that has been demonstrated to provide comparable clinical outcomes, home testing pathways incur additional costs to compensate for failed studies and lower diagnostic accuracy. A cost-minimization analysis from a randomized controlled trial showed that the cost advantage of a home management pathway narrowed significantly when these additional costs are considered. Further, when the actual costs of providing HSAT rather than what is reimbursed by insurance were considered, the cost advantage was further attenuated. A comprehensive cost-effectiveness analysis (CEA), favored a lab over a home approach based on modeling that projected that the costs of erroneous diagnosis over a long time span for the home approach outweighed lower test costs. Studies have identified the following factors that influence costeffectiveness of home-based management: cost of untreated OSA, prevalence of OSA, performance characteristics of the selected test, time horizon, and whether backup PSG is used for failed HSAT. More clinical studies are needed to provide the inputs for more robust CEA regarding this issue.

Implementation of Synchronous Telemedicine into Clinical Practice

“…What used to require fully attended polysomnography can now be accomplished in the patient’s home faster and in a more cost-effective manner. 26 Clinicians are able to reach patients who would otherwise never be seen by using telemedicine technology. 27 This, in turn, helps to keep communities healthier and keep health care dollars within those communities.…”

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].…”

“…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]. In contrast, the most recent review has focused on constructing a cost-effectiveness model of OSA management based on existing data [59].…”

Insomnia analysis based on internet of things using electrocardiography and electromyography

“…The demand of the diagnosis is influenced by prevalence and incidence of the disease, cost and patient reimbursement policies, patient and primary physician awareness and wait times where the capacity of the treatment dictate by availability of sleep laboratory beds determined by funding policies, availability of sleep specialists, and policies about order or interpret diagnostic polysomnography studies [12]. Treatments and assessments of insomnia using polysomnographic turn out to have socio-economic problems, but for some cases is not good enough in patients who are difficult to mobility [13,14]. So we need a tool with a method of use that can make it easier for patients to undergo treatment that is cheap and easy to apply daily.…”