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Current Sleep Medicine Reports
Published in: Current Sleep Medicine Reports 2/2016

01-06-2016 | Sleep Related Breathing Disorders (T Lee-Chiong, Section Editor)

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

Authors: Ken He, Richard Kim, Vishesh K. Kapur

Published in: Current Sleep Medicine Reports | Issue 2/2016

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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 cost-effectiveness 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.
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Metadata
Title
Home- vs. Laboratory-Based Management Of OSA: An Economic Review
Authors
Ken He
Richard Kim
Vishesh K. Kapur
Publication date
01-06-2016
Publisher
Springer International Publishing
Published in
Current Sleep Medicine Reports / Issue 2/2016
Electronic ISSN: 2198-6401
DOI
https://doi.org/10.1007/s40675-016-0042-3

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