An Integrated Health-Economic Analysis of Diagnostic and Therapeutic Strategies in the Treatment of Moderate-to-Severe Obstructive Sleep Apnea
Open accessAbstract
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a common disorder associated with substantially increased cardiovascular risks, reduced quality of life, and increased risk of motor vehicle collisions due to daytime sleepiness. This study evaluates the cost-effectiveness of three commonly used diagnostic strategies (full-night polysomnography, split-night polysomnography, unattended portable home-monitoring) in conjunction with continuous positive airway pressure (CPAP) therapy in patients with moderate-to-severe OSA. DESIGN: A Markov model was created to compare costs and effectiveness of different diagnostic and therapeutic strategies over a 10-year interval and the expected lifetime of the patient. The primary measure of cost-effectiveness was incremental cost per quality-adjusted life year (QALY) gained. PATIENTS OR PARTICIPANTS: Baseline computations were performed for a hypothetical average cohort of 50-year-old males with a 50% pretest probability of having moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour). MEASUREMENTS AND RESULTS: For a patient with moderate-to-severe OSA, CPAP therapy has an incremental cost-effectiveness ratio (ICER) of $15,915 per QALY gained for the lifetime horizon. Over the lifetime horizon in a population with 50% prevalence of OSA, full-night polysomnography in conjunction with CPAP therapy is the most economically efficient strategy at any willingness-to-pay greater than $17,131 per-QALY gained because it dominates all other strategies in comparative analysis. CONCLUSIONS: Full-night polysomnography (PSG) is cost-effective and is the preferred diagnostic strategy for adults suspected to have moderate-to-severe OSA when all diagnostic options are available. Split-night PSG and unattended home monitoring can be considered cost-effective alternatives when full-night PSG is not available.
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One study demonstrated an incremental cost-effectiveness ratio of CDN$15,915 per quality-adjusted life year with CPAP therapy.
“The first study 167 demonstrated an incremental cost-effectiveness ratio (ICER) of CDN$15,915 per quality-adjusted life year (QALY) with CPAP therapy”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [167]
The Results report an ICER of $15,915 per QALY gained for CPAP compared with no treatment over a lifetime horizon. The paper specifies that its values are in 2008 U.S. dollars, not Canadian dollars, so the CDN$ designation is unsupported. (LLM, conf=0.94)
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Latest Advances in Sleep Medicine
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- Authors
- Pietzsch, J. B., Garner, A. M., Cipriano, L. E., & Linehan, J. H.
- Affiliations
- Stanford University (US)
- Northwestern University (US)
- Corresponding author
- John H. Linehan
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-06-01
- Volume
- 34
- Issue
- 6
- Pages
- 695-709
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3098944
- OpenAlex
- W2085685282
- Cited by
- 149
- References
- 67
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 7 · 2020: 3 · 2019: 7 · 2018: 7 · 2017: 17 · 2016: 14 · 2015: 23 · 2014: 13 · 2013: 16 · 2012: 12
- FWCI
- 9.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Northwestern University
- 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, cost-effectiveness, split-night polysomnography, home sleep apnea testing, continuous positive airway pressure, OSA diagnosis, quality-adjusted life years, Markov model
- MeSH terms
- Adult, Cost-Benefit Analysis, Female, Humans, Male, Markov Chains, Health Care Costs, Outcome Assessment, Health Care, Polysomnography, Quality-Adjusted Life Years, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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