An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea.
Sleep
; 38(7): 1027-37, 2015 Jul 01.
Article
em En
| MEDLINE
| ID: mdl-26118558
ABSTRACT
STUDY OBJECTIVES:
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).DESIGN:
A cost-minimization analysis from the payer and provider perspectives was performed, given that 3-mo clinical outcomes were equivalent.SETTING:
Seven academic sleep centers.PARTICIPANTS:
There were 373 subjects at high risk for moderate to severe OSA.INTERVENTIONS:
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. MEASUREMENTS ANDRESULTS:
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. CLINICALTRIALSGOV IDENTIFIER NCT00642486.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Custos de Cuidados de Saúde
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Apneia Obstrutiva do Sono
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Medicina do Sono
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Serviços de Assistência Domiciliar
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Laboratórios
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
/
Health_economic_evaluation
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Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
Sleep
Ano de publicação:
2015
Tipo de documento:
Article
País de publicação:
EEUU
/
ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
/
UNITED STATES
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UNITED STATES OF AMERICA
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US
/
USA