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Cited by 105Obstructive Sleep Apnea ResearchHealth Systems, Economic Evaluations, Quality of LifeSleep and related disorders

An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea

Open access
Kim, Richard D., Kapur, Vishesh K., Redline-Bruch, Julie, Rueschman, Michael, Auckley, Dennis H., Benca, Ruth M., Foldvary-Schafer, Nancy R., Iber, Conrad +4 more·2015·Sleep
DOI 10.5665/sleep.4804PMC PMC4481018
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Abstract

STUDY OBJECTIVES: We conducted an economic analysis of the HomePAP study, a multicenter randomized clinical trial that compared home-based 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. CLINICALTRIALSGOV IDENTIFIER: NCT00642486.

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  • Home-based testing can broaden access to diagnostic services and may reduce economic burden while providing similar effectiveness.

    “Home-based testing can broaden access to diagnostic services, in hopes to reduce the substantial economic burden related to OSA and provide consistent results signifying similar effectiveness.138”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [138]

    The Discussion (page not available) reports similar clinical outcomes for high-risk OSA patients and lower costs for payers using the home-based pathway. It does not establish that home testing broadens access to diagnostic services, and its cost finding does not extend to providers, for whom the strategies had similar costs. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Some of the cost advantage with use of home sleep testing ($167 vs $782 for lab study) was offset by the need for additional testing in some patients who failed or had non-diagnostic home studies.

    “Some of the cost advantage with use of home sleep testing ($167 vs. $782 for lab study) was offset by the need for additional testing in some patients who have failed or had non-diagnostic home studies.138”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [138]

  • A subsequent cost minimization analysis of this RCT also considered costs from a provider perspective.

    “A subsequent cost minimization analysis of this RCT also considered costs from a provider perspective.115”

    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 [115]

  • Neck circumference is associated with OSA severity.

    “Neck circumference is associated with OSA severity.138,528”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [138]

    The Study Design passages describe OSA classification by apnea–hypopnea index, and the Economic Analysis passages address testing and costs; neither discusses neck circumference or its relationship to OSA severity. Searches for “neck circumference” and related association terms found no passage addressing the claim. No page number was provided for these passages. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 2

  1. [7]7. Holman FA. Home Testing Surges as Bed Growth Declines. Sleep Rev 2013;14:16-7.
  2. [13]13. Barber JA, Thompson SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 2000;19:3219-36.

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Authors
Kim, R. D., Kapur, V. K., Redline-Bruch, J., Rueschman, M., Auckley, D. H., Benca, R. M., Foldvary-Schafer, N. R., Iber, C., Zee, P. C., Rosen, C. L., Redline, S., & Ramsey, S. D.
Affiliations
  • University of Washington (US)
  • Mathematica Policy Research (US)
  • Brigham and Women's Hospital (US)
  • MetroHealth Medical Center (US)
  • University of Wisconsin–Madison (US)
  • Cleveland Clinic (US)
  • University of Minnesota (US)
  • Northwestern University (US)
  • Case Western Reserve University (US)
  • Fred Hutch Cancer Center (US)
Corresponding author
Kim, Richard D.
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2015-07-01
Volume
38
Issue
7
Pages
1027-1037
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.5665/sleep.4804
PMC
PMC4481018
OpenAlex
W2202676031
Semantic Scholar
bef6b87eedeea5326ae464660c2479b5b2d45543
Cited by
105
References
31
Citations by year
2026: 10 · 2025: 8 · 2024: 9 · 2023: 9 · 2022: 9 · 2021: 10 · 2020: 11 · 2019: 8 · 2018: 9 · 2017: 11 · 2016: 9 · 2015: 2
FWCI
7.62
Type
journal article
Language
en
Open access
Locations
  • SLEEP (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
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, home sleep testing, cost comparison, continuous positive airway pressure, CPAP titration, payer perspective, sleep apnea diagnosis
MeSH terms
Home Care Services, Humans, Laboratories, Treatment Outcome, Health Care Costs, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, Sleep Medicine Specialty

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