Cost-Effectiveness of Split-Night Polysomnography and Home Studies in the Evaluation of Obstructive Sleep Apnea Syndrome
Abstract
Study objectives Split-night polysomnography (PSG) and unattended home sleep studies have come into use as less-expensive tests for obstructive sleep apnea syndrome, but their impact on cost-effectiveness of the overall evaluation and treatment is unknown. We compared the cost-effectiveness of evaluations that employ these 2 procedures with a conventional approach using full-night PSG. Methods We used a decision-tree model that incorporated typical clinical algorithms for each of the 3 strategies to compare their cost-effectiveness from a third-party payer perspective over a 5-year period. Probabilities and test characteristics were derived from data from the published literature. Cost estimates were based on the 2004 Medicare Fee Schedule. Survival rates were taken from National Center for Health Statistics data and published studies. Effectiveness was measured as quality-adjusted life years. Results Trade-offs of overall costs versus effectiveness were identified. The home-studies strategy was less costly and less effective than split-night PSG and full-night PSG, as was split-night PSG compared with full-night PSG. Costs to attain additional quality-adjusted life years were below commonly accepted thresholds. A probabilistic analysis suggested that the home-studies approach was most cost-effective at the lowest amounts of third-party willingness to pay, whereas split-night PSG or full-night PSG was most cost-effective at higher amounts. Conclusions Home studies and split-n…
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Economic analyses have compared the cost-effectiveness of management pathways that incorporate diagnostic strategies using HSAT or PSG.
“Economic analyses have compared the cost-effectiveness of management pathways that incorporate diagnostic strategies using HSAT or PSG.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [112]
All economic analyses have concluded that PSG is the preferred diagnostic strategy from an economic perspective for adults suspected to have moderate to severe OSA.
“All have concluded that PSG is the preferred diagnostic strategy from an economic perspective for adults suspected to have moderate to severe OSA.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [112]
Our literature search yielded nine studies that met inclusion criteria.
“Our literature search yielded nine studies that met inclusion criteria.112,121–128”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [112]
A study that did not provide data suitable for inclusion in a meta-analysis examined cost-effectiveness of the split-night study versus the full-night study.
“A study that did not provide data suitable for inclusion in a meta-analysis examined cost-effectiveness of the split-night study versus the full-night study.”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [112]
A single cost-effectiveness analysis demonstrated that split-night studies were less costly than full-night studies based on cost per QALY gained ($1,979 versus $2,092) and would be considered more cost-effective than full-night studies when third-party willingness to pay fell below $11,500 per QALY gained.
“A single cost-effectiveness analysis demonstrated that split-night studies were less costly than full-night studies based on cost per quality of life year (QALY) gained ($1,979 versus $2,092) and would be considered more cost-effective than full-night studies when third-party willingness to pay fell below $11,500 per QALY gained (a level of cost per QALY that would still be considered a good value”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [112]
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- Authors
- Deutsch, P. A., Simmons, M. S., & Wallace, J. M.
- Affiliations
- Williams College (US)
- University of California, Los Angeles (US)
- Olive View-UCLA Medical Center (US)
- ORCID
- Wallace, Jeanne M.
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2006-04-15
- Volume
- 2
- Issue
- 2
- Pages
- 145-153
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- OpenAlex
- W96268920
- Cited by
- 103
- References
- 2
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 5 · 2021: 9 · 2020: 5 · 2019: 5 · 2018: 3 · 2017: 9 · 2016: 7 · 2015: 8 · 2014: 9 · 2013: 9 · 2012: 3
- FWCI
- 1.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Sleep Medicine (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
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, split-night polysomnography, home sleep testing, cost-effectiveness, quality-adjusted life years, sleep apnea diagnosis, decision tree, willingness-to-pay threshold, Medicare spending
- MeSH terms
- Cost-Benefit Analysis, Decision Trees, Home Care Services, Humans, Severity of Illness Index, Sleep Apnea Syndromes, Polysomnography, Models, Economic, Continuous Positive Airway Pressure
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