TY - JOUR
T1 - An economic evaluation of home versus laboratory-based diagnosis of obstructive sleep apnea
AU - Kim, Richard D.
AU - Kapur, Vishesh K.
AU - Redline-Bruch, Julie
AU - Rueschman, Michael
AU - Auckley, Dennis H.
AU - Benca, Ruth M.
AU - Foldvary-Schafer, Nancy R.
AU - Iber, Conrad
AU - Zee, Phyllis C.
AU - Rosen, Carol L.
AU - Redline, Susan
AU - Ramsey, Scott D.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - 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.
AB - 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.
KW - Cost effectiveness analysis
KW - Cost minimization analysis
KW - Home sleep testing
KW - Obstructive sleep apnea
KW - Operating margin
KW - Out-of-center testing
KW - Portable monitor
KW - Sleep medicine
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U2 - 10.5665/sleep.4804
DO - 10.5665/sleep.4804
M3 - Article
C2 - 26118558
AN - SCOPUS:84938083867
SN - 0161-8105
VL - 38
SP - 1027
EP - 1037
JO - Sleep
JF - Sleep
IS - 7
ER -