Cost-Benefit Analysis From the Payor's Perspective for Screening and Diagnosing Obstructive Sleep Apnea During Inpatient Rehabilitation for Moderate to Severe TBI

Arch Phys Med Rehabil. 2020 Sep;101(9):1497-1508. doi: 10.1016/j.apmr.2020.03.020. Epub 2020 May 4.


Objective: To describe the cost benefit of 4 different approaches to screening for sleep apnea in a cohort of participants with moderate to severe traumatic brain injury (TBI) receiving inpatient rehabilitation from the payor's perspective.

Design: A cost-benefit analysis of phased approaches to sleep apnea diagnosis.

Setting: Six TBI Model System Inpatient Rehabilitation Centers.

Participants: Trial data from participants (N=214) were used in analyses (mean age 44±18y, 82% male, 75% white, with primarily motor vehicle-related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8±5).

Intervention: Not applicable.

Main outcome: Cost benefit.

Results: At apnea-hypopnea index (AHI) ≥15 (34%), phased modeling approaches using screening measures (Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender [STOPBANG] [-$5291], Multivariable Apnea Prediction Index MAPI [-$5262]) resulted in greater cost savings and benefit relative to the portable diagnostic approach (-$5210) and initial use of laboratory-quality polysomnography (-$5,011). Analyses at AHI≥5 (70%) revealed the initial use of portable testing (-$6323) relative to the screening models (MAPI [-$6250], STOPBANG [-$6237) and initial assessment with polysomnography (-$5977) resulted in greater savings and cost-effectiveness.

Conclusions: The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-beneficial approach varying by incidence of OSA.

Trial registration: NCT03033901.

Keywords: Brain; Cost-benefit analysis; Polysomnography; Rehabilitation; Sleep apnea syndromes; Wounds and injuries.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Body Weights and Measures
  • Brain Injuries, Traumatic / rehabilitation*
  • Cost-Benefit Analysis
  • Female
  • Glasgow Coma Scale
  • Humans
  • Inpatients
  • Male
  • Mass Screening / economics*
  • Middle Aged
  • Polysomnography
  • Sex Factors
  • Sleep Apnea, Obstructive / diagnosis*
  • Snoring
  • Socioeconomic Factors

Associated data