title: An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  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.
authors.affiliation: Wing Tech Inc., Menlo Park, CA, USA.
authors.forename: Jan B
authors.initials: JB
authors.lastname: Pietzsch
authors.forename: Abigail
authors.initials: A
authors.lastname: Garner
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cipriano
authors.forename: John H
authors.initials: JH
authors.lastname: Linehan
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D017063:Outcome Assessment, Health Care; D017286:Polysomnography / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*