Cost-benefit analysis from the payor’s perspective for screening and diagnosing obstructive sleep apnea during inpatient rehabilitation for moderate to severe TBI
Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):
, 101, 9, 1497-1508
Study examined the cost benefit of 4 different approaches to screening for sleep apnea from the payor’s perspective in people with moderate-to-severe traumatic brain injury (TBI) receiving inpatient rehabilitation. The first approach evaluates the initial use of portable diagnostic testing prior to laboratory-quality assessment for all those who test negative. The second and third approaches involve initial screening with questionnaires prior to the use of the portable diagnostic study, followed by laboratory-based testing for those with negative portable diagnostic studies. Finally, the fourth approach used laboratory-based testing for all participants. Data from 214 participants from 6 TBI Model System inpatient rehabilitation centers were used in analyses. Participants were administered screening questionnaires (the Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender [STOPBANG] or the Multivariable Apnea Prediction Index [MAPI]); portable diagnostic testing for sleep apnea; and the criterion standard, level-1 polysomnography. At apnea-hypopnea index (AHI) ≥15, phased modeling approaches using screening measures (STOPBANG and MAPI) resulted in greater cost savings and benefit relative to the portable diagnostic approach and initial use of laboratory-quality polysomnography. Analyses at AHI ≥5 revealed the initial use of portable testing relative to the screening models and initial assessment with polysomnography resulted in greater savings and cost-effectiveness. The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-beneficial approach varying by incidence of OSA.
Nakase-Richardson, Risa |Hoffman, Jeanne M. |Magalang, Ulysses |Almeida, Emily |Schwartz, Daniel J. |Drasher-Phillips, Leah |Whyte, John |Bogner, Jennifer |Dismuke-Greer, Clara E.|