title: Cost-effectiveness of obstructive sleep apnea screening for patients with diabetes or chronic kidney disease.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is a common disorder with a high prevalence among patients with cardiovascular disease (CVD), diabetes, and chronic kidney disease (CKD). Routine evaluation of OSA for patients with CVD including hypertension has been performed according to the clinical guidelines for both OSA and CVD. However, most patients with diabetes and CKD who could benefit from treatment remain undiagnosed because routine screening of OSA is not recognized as part of standard practice. This study aims to evaluate the cost-effectiveness of OSA screening for patients with diabetes and CKD.
  
  
  METHODS
  Cost-effectiveness analysis by a decision tree and Markov modeling from the societal perspective in Japan was carried out to provide evidence based on the economic evaluation of current clinical practice concerning diabetes and CKD.
  
  
  RESULTS
  Incremental cost-effectiveness ratios of OSA screening compared with do-nothing were calculated as ¥3,516,976 to 4,514,813/quality-adjusted life year (QALY) (US$35,170 to 45,148/QALY) for diabetes patients and ¥3,666,946 to 4,006,866/QALY (US$36,669 to 40,069/QALY) for CKD patients.
  
  
  CONCLUSIONS
  Taking the threshold to judge cost-effectiveness according to a suggested value of social willingness to pay for one QALY gain in Japan as ¥5 million/QALY (US$50,000QALY), OSA screening is cost-effective. Our results suggest that active case screening and treatment of OSA for untreated middle-aged male patients with diabetes or CKD could be justifiable as an efficient use of finite health-care resources in the world with high prevalence of these diseases.
authors: Department of Nephrology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8577, Japan.
authors: Reiko
authors: R
authors: Okubo
authors: Masahide
authors: M
authors: Kondo
authors: Shu-ling
authors: SL
authors: Hoshi
authors: Kunihiro
authors: K
authors: Yamagata
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000191:economics; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003663:Decision Trees; D048909:Diabetes Complications / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000191:economics; D017286:Polysomnography / Q000191:economics; D019057:Quality-Adjusted Life Years; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology
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