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A Cost-Effectiveness Analysis of Alternative At-Home or In-Laboratory Technologies for the Diagnosis of Obstructive Sleep Apnea Syndrome

Department of Health Policy and Management, Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Eithan Schweitzer, DSc

Planning and Control Department, Kupat Holim Clalit, Tel-Aviv, and the Department of Technology Management, Center for Technological Education Holon, Beer-Sheva, Israel

Ariel Tarasiuk, PhD

Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, Sleep-Wake Disorders Center, Soroka Medical Center, Beer-Sheva, Israel

Background. Obstructive sleep apnea syndrome (OSAS) is a common disorder that affects 2% to 9% of the population. Health care policy makers have noted increased referrals for sleep studies. Objective. In this article, the authors conduct a cost-effectiveness analysis to determine the optimal technology for the diagnosis of OSAS using polysomnography (PSG) or partial sleep monitoring (PSM). Design. The target population was a hypothetical cohort of patients suspected of having OSAS. A 2-level decision tree was formulated that reflects all possible steps of OSAS diagnosis and therapy. The method represents a comprehensive strategy to determine which of the 2 systems—PSG or PSM—has cost advantages. The financial and operational aspects of OSAS diagnosis and therapy were analyzed. A sensitivity analysis was performed over all uncertain parameters (i.e., diagnostic agreement, data loss, and referral to therapy). Results. Unattended at-home sleep monitoring was the most expensive method. The combination of 1:2 PSG and attended PSM strategy was the optimal strategy with respect to financing and operations. Compared to the PSG-only strategy, this combination may lead to a 10% reduction of the annual expenditure. Conclusion. This study provides proof of concept (under a wide range of sensitivity assumptions) that the cost of sleep study techniques can be modeled. It rejects the assumption that at-home portable sleep monitoring is cost advantageous. The combination of PSG and attended PSM OSAS is the most cost-effective approach to sleep evaluation.

Key Words: sleep apnea • polysomnography • unattended sleep monitoring • cost analysis

Medical Decision Making, Vol. 21, No. 6, 451-458 (2001)
DOI: 10.1177/0272989X0102100603


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