Cited by 149Obstructive Sleep Apnea ResearchHealth Systems, Economic Evaluations, Quality of LifeSleep and related disorders

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An Integrated Health-Economic Analysis of Diagnostic and Therapeutic Strategies in the Treatment of Moderate-to-Severe Obstructive Sleep Apnea

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Jan Benjamin Pietzsch, Abigail M. Garner, Lauren E. Cipriano, John H. Linehan·2011·Sleep

DOI 10.5665/sleep.1030PMC PMC3098944

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Abstract

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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Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study
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Self-citation
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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
ORCID: Jan Benjamin Pietzsch
Lauren E. Cipriano
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
DOI: 10.5665/sleep.1030
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 (medical) › 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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An Integrated Health-Economic Analysis of Diagnostic and Therapeutic Strategies in the Treatment of Moderate-to-Severe Obstructive Sleep Apnea

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