Study objectives: Split-night polysomnography (PSG) and unattended home sleep studies have come into use as less-expensive tests for obstructive sleep apnea syndrome, but their impact on cost-effectiveness of the overall evaluation and treatment is unknown. We compared the cost-effectiveness of evaluations that employ these 2 procedures with a conventional approach using full-night PSG.
Methods: We used a decision-tree model that incorporated typical clinical algorithms for each of the 3 strategies to compare their cost-effectiveness from a third-party payer perspective over a 5-year period. Probabilities and test characteristics were derived from data from the published literature. Cost estimates were based on the 2004 Medicare Fee Schedule. Survival rates were taken from National Center for Health Statistics data and published studies. Effectiveness was measured as quality-adjusted life years.
Results: Trade-offs of overall costs versus effectiveness were identified. The home-studies strategy was less costly and less effective than split-night PSG and full-night PSG, as was split-night PSG compared with full-night PSG. Costs to attain additional quality-adjusted life years were below commonly accepted thresholds. A probabilistic analysis suggested that the home-studies approach was most cost-effective at the lowest amounts of third-party willingness to pay, whereas split-night PSG or full-night PSG was most cost-effective at higher amounts.
Conclusions: Home studies and split-night PSG are cost-effective alternatives to full-night PSG. Willingness-to-pay is an important consideration in choosing the most cost-effective approach. This study points out the importance of considering the complexities within the entire process of obstructive sleep apnea syndrome evaluation when comparing costs among different procedures.