title: An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  A cost-minimization analysis from the payer and provider perspectives was performed, given that 3-mo clinical outcomes were equivalent.
  
  
  METHODS
  Seven academic sleep centers.
  
  
  METHODS
  There were 373 subjects at high risk for moderate to severe OSA.
  
  
  METHODS
  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.
  
  
  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.
  
  
  BACKGROUND
  NCT00642486.
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA.|Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA.|Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Vishesh K
authors.initials: VK
authors.lastname: Kapur
authors.affiliation: Mathematica Policy Research, Cambridge, MA.
authors.forename: Julie
authors.initials: J
authors.lastname: Redline-Bruch
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rueschman
authors.affiliation: MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Auckley
authors.affiliation: University of Wisconsin, Madison, WI.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Benca
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Foldvary-Schafer
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Conrad
authors.initials: C
authors.lastname: Iber
authors.affiliation: Northwestern University, Chicago, IL.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
authors.affiliation: University Hospitals, Case Western Reserve University, Cleveland, OH.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
mesh_terms: D045422:Continuous Positive Airway Pressure; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007753:Laboratories / Q000191:economics*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D056508:Sleep Medicine Specialty / Q000191:economics* / Q000379:methods*; D016896:Treatment Outcome
keywords: cost effectiveness analysis; cost minimization analysis; home sleep testing; obstructive sleep apnea; operating margin; out-of-center testing; portable monitor; sleep medicine