An economic evaluation of home versus laboratory-based diagnosis of obstructive sleep apnea

Richard D. Kim, Vishesh K. Kapur, Julie Redline-Bruch, Michael Rueschman, Dennis H. Auckley, Ruth M. Benca, Nancy R. Foldvary-Schafer, Conrad Iber, Phyllis C. Zee, Carol L. Rosen, Susan Redline, Scott D. Ramsey

Research output: Contribution to journalArticle

42 Scopus citations

Abstract

Study Objectives: We conducted an economic analysis of the HomePAP study, a multicenter randomized clinical trial that compared homebased versus laboratory-based testing for the diagnosis and management of obstructive sleep apnea (OSA). Design: A cost-minimization analysis from the payer and provider perspectives was performed, given that 3-mo clinical outcomes were equivalent. Setting: Seven academic sleep centers. Participants: There were 373 subjects at high risk for moderate to severe OSA. Interventions: Subjects were randomized to either home-based limited channel portable monitoring followed by unattended autotitration with continuous positive airway pressure (CPAP), versus a traditional pathway of in-laboratory sleep study and CPAP titration. Measurements and Results: From the payer perspective, per subject costs for the laboratory-based pathway were $1,840 (95% confidence interval [CI] $1,660, $2,015) compared to $1,575 (95% CI $1,439, $1,716) for the home-based pathway under the base case. Costs were $264 (95% CI $39, $496, P = 0.02) in favor of the home arm. From the provider perspective, per subject costs for the laboratory arm were $1,697 (95% CI $1,566, $1,826) compared to $1,736 (95% CI $1,621, $1,857) in the home arm, for a difference of $40 (95% CI -$213, $142, P = 0.66) in favor of the laboratory arm under the base case. The provider operating margin was $142 (95% CI $85, $202,P < 0.01) in the laboratory arm, compared to a loss of -$161 (95% CI -$202, -$120, P < 0.01) in the home arm. Conclusions: For payers, a home-based diagnostic pathway for obstructive sleep apnea with robust patient support incurs fewer costs than a laboratory-based pathway. For providers, costs are comparable if not higher, resulting in a negative operating margin.

Original languageEnglish (US)
Pages (from-to)1027-1037
Number of pages11
JournalSleep
Volume38
Issue number7
DOIs
StatePublished - Jul 1 2015

Keywords

  • Cost effectiveness analysis
  • Cost minimization analysis
  • Home sleep testing
  • Obstructive sleep apnea
  • Operating margin
  • Out-of-center testing
  • Portable monitor
  • Sleep medicine

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    Kim, R. D., Kapur, V. K., Redline-Bruch, J., Rueschman, M., Auckley, D. H., Benca, R. M., Foldvary-Schafer, N. R., Iber, C., Zee, P. C., Rosen, C. L., Redline, S., & Ramsey, S. D. (2015). An economic evaluation of home versus laboratory-based diagnosis of obstructive sleep apnea. Sleep, 38(7), 1027-1037. https://doi.org/10.5665/sleep.4804