Multiple-access versus telemedicine home-based sleep apnea testing for obstructive sleep apnea (OSA) diagnosis: a cost-minimization study

Abstract

PurposeThe aim of the present study was to compare two clinical pathways: the multiple-access outpatient pathway versus the telemedicine pathway. Methods The multiple-access outpatient pathway and the telemedicine pathway were both performed with WatchPAT and implemented in a real-life healthcare scenario, adopting a cost-minimization approach. A cost-minimization analysis was undertaken to assess the economic impact of the two alternatives. The cost analyses were performed in euros for the year 2021 adopting the patient, the hospital, and the societal perspectives. Given the chosen perspectives, direct medical costs, direct nonmedical costs, and indirect costs were considered. In addition, a univariate sensitivity analysis was conducted. Results From a hospital perspective, the telemedicine approach was estimated to cost €49 more than the multiple-access alternative. Considering the patient perspective, the telemedicine approach was estimated to cost €167 less than the multipleaccess pathway. Considering the societal perspective, the telemedicine approach is estimated to cost €119 less than the multiple-access pathway. ConclusionThe adoption of telemedicine home sleep apnea testing could improve the efficiency of the healthcare processes if considering the direct and indirect costs incurred by patients and not only by healthcare providers.

The Future of Telemedicine for Obstructive Sleep Apnea Treatment: A Narrative Review

“…Home sleep studies (home sleep apnea testing or HSAT) offer a more accessible and convenient alternative to traditional in-lab sleep studies. Patients can conduct sleep studies in the comfort of their homes, which may increase overall participation in diagnostic assessments, especially among those who might find attending a sleep clinic challenging and expensive [42]. This advancement signifies a new potential avenue for expanding access to both diagnosis and treatment for OSA, addressing critical gaps in care exacerbated by the pandemic.…”

The role of the WatchPAT device in the diagnosis and management of obstructive sleep apnea

“…A cost-effectiveness study using an unspecified WP device found that the telemedicine pathway was more expensive for the healthcare provider but significantly cheaper for patients, indicating that a telemedicine service with WP devices would be acceptable to the patient population (Di Pumpo et al, 2022). Use of the WP device rather than full PSGs in traditional outpatient services has been shown to reduce time to OSA diagnosis and treatment, leading to overall cost savings (Phua et al, 2021).…”

Remote Titration of Mandibular Advancement Devices: What Outcomes Should We Target?

“…Although sleep testing can guide treatment, these tests pose meaningful access barriers and costs to patients and the healthcare system. In-laboratory testing is a particular concern because it requires substantial patient time and travel along with major investments from healthcare systems for dedicated facilities and staff ( 6 , 7 ). Although home sleep apnea testing can alleviate many of these barriers, home tests can still require staff time for study retrieval, scoring, and interpretation ( 7 ).…”

“…In-laboratory testing is a particular concern because it requires substantial patient time and travel along with major investments from healthcare systems for dedicated facilities and staff ( 6 , 7 ). Although home sleep apnea testing can alleviate many of these barriers, home tests can still require staff time for study retrieval, scoring, and interpretation ( 7 ). Together, these barriers and costs limit the feasibility of follow-up sleep testing among patients treated with MADs.…”

“…Through remote monitoring, MJM analysis could reduce patient burdens associated with testing, including time and travel. Moreover, automated scoring could improve health system access and efficiency by liberating specialized staff for other patient care activities ( 6 , 7 ). Further harnessing the potential of digital medicine, the investigators also used an electronic platform to remotely assess patients’ sleep symptoms and device-related tolerability.…”