An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea

Sleep. 2011 Jun 1;34(6):695-709. doi: 10.5665/SLEEP.1030.


Study objectives: 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.

Design: 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.

Patients or participants: 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).

Measurements and 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.

Keywords: Markov model; Sleep apnea; comparative effectiveness; continuous positive airway pressure; health-economics; obstructive.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Continuous Positive Airway Pressure / economics*
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs*
  • Humans
  • Male
  • Markov Chains
  • Outcome Assessment, Health Care
  • Polysomnography / economics*
  • Polysomnography / methods
  • Quality-Adjusted Life Years
  • Sleep Apnea, Obstructive / diagnosis*
  • Sleep Apnea, Obstructive / economics
  • Sleep Apnea, Obstructive / therapy*