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Cited by 22Obstructive Sleep Apnea ResearchHealth Systems, Economic Evaluations, Quality of LifeHealthcare cost, quality, practices

Cost-effectiveness Analysis of Preoperative Screening Strategies for Obstructive Sleep Apnea among Patients Undergoing Elective Inpatient Surgery

Open access
Sankar, Ashwin, Dixon, Peter R., Sivanathan, Lavarnan, Memtsoudis, Stavros G., de Almeida, John R., Singh, Mandeep·2020·Anesthesiology
DOI 10.1097/aln.0000000000003429
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Abstract

Background: Obstructive sleep apnea is underdiagnosed in surgical patients. The cost-effectiveness of obstructive sleep apnea screening is unknown. This study’s objective was to evaluate the cost-effectiveness of preoperative obstructive sleep apnea screening (1) perioperatively and (2) including patients’ remaining lifespans. Methods: An individual-level Markov model was constructed to simulate the perioperative period and lifespan of patients undergoing inpatient elective surgery. Costs (2016 Canadian dollars) were calculated from the hospital perspective in a single-payer health system. Remaining model parameters were derived from a structured literature search. Candidate strategies included: (1) no screening; (2) STOP-Bang questionnaire alone; (3) STOP-Bang followed by polysomnography (STOP-Bang + polysomnography); and (4) STOP-Bang followed by portable monitor (STOP-Bang + portable monitor). Screen-positive patients (based on STOP-Bang cutoff of at least 3) received postoperative treatment modifications and expedited definitive testing. Effectiveness was expressed as quality-adjusted life month in the perioperative analyses and quality-adjusted life years in the lifetime analyses. The primary outcome was the incremental cost-effectiveness ratio. Results: In perioperative and lifetime analyses, no screening was least costly and least effective. STOP-Bang + polysomnography was the most effective strategy and was more cost-effective than both STOP-Bang + portable monitor and STOP-Bang alone in both analyses. In perioperative analyses, STOP-Bang + polysomnography was not cost-effective compared to no screening at the $4,167/quality-adjusted life month threshold (incremental cost-effectiveness ratio $52,888/quality-adjusted life month). No screening was favored in more than 90% of iterations in probabilistic sensitivity analyses. In contrast, in lifetime analyses, STOP-Bang + polysomnography was favored compared to no screening at the $50,000/quality-adjusted life year threshold (incremental cost-effectiveness ratio $2,044/quality-adjusted life year). STOP-Bang + polysomnography was favored in most iterations at thresholds above $2,000/quality-adjusted life year in probabilistic sensitivity analyses. Conclusions: The cost-effectiveness of preoperative obstructive sleep apnea screening differs depending on time horizon. Preoperative screening with STOP-Bang followed by immediate confirmatory testing with polysomnography is cost-effective on the lifetime horizon but not the perioperative horizon. The integration of preoperative screening based on STOP-Bang and polysomnography is a cost-effective means of mitigating the long-term disease burden of obstructive sleep apnea. Editor’s Perspective: What We Already Know about This Topic: What This Article Tells Us That Is New:

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  • The preoperative assessment is a cost-effective opportunity to screen for and select high-risk patients who can then be offered sleep study and treatment for OSA.

    “the preoperative assessment is a cost-effective opportunity to screen for and select high risk patients who can then be offered sleep study and treatment for OSA.”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [488]

    The Discussion (page not available in our copy) favors preoperative STOP-Bang screening followed by polysomnography for screen-positive patients when costs and benefits are assessed over a lifetime. It also says no screening was favored when only the perioperative period was considered. The claim omits that qualification on cost-effectiveness. (LLM, conf=0.86)

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Research works printed but not linked: 1

  1. [10]10. Obstructive sleep apnea and complication-related utilities and hazard ratios were multiplicative. 38 Cost-effectiveness of Sleep Apnea Screening Sankar et al. with obstructive sleep apnea: A meta-analysis. J Clin Anesth 2014; 26:591-600

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Related

Authors
Sankar, A., Dixon, P. R., Sivanathan, L., Memtsoudis, S. G., de Almeida, J. R., & Singh, M.
Affiliations
Hospital for Special Surgery (US)
ORCID
Venue
Anesthesiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-06-26
Volume
133
Issue
4
Pages
787-800
ISSN
  • 0003-3022 (ISSN-L)
  • 1528-1175
DOI
10.1097/aln.0000000000003429
OpenAlex
W3037525567
Cited by
22
References
56
Citations by year
2026: 3 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 5 · 2020: 1
FWCI
2.10
Type
journal article
Language
en
Open access
Locations
  • Anesthesiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords
obstructive sleep apnea, preoperative screening, cost-effectiveness, STOP-BANG questionnaire, polysomnography, quality-adjusted life years, time horizon, perioperative period, single-payer health care, hospital costs, Markov model simulation
MeSH terms
Aged, Cost-Benefit Analysis, Female, Humans, Male, Markov Chains, Mass Screening, Middle Aged, Preoperative Care, Polysomnography, Elective Surgical Procedures, Sleep Apnea, Obstructive

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