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- W2000261577 abstract "The cost implications of adopting portable monitoring devices for the diagnosis of obstructive sleep apnea (OSA) are largely unknown. We conducted an economic analysis of the HomePAP study, a multi-center randomized clinical trial that compared home-based versus lab-based testing for the management of OSA in accredited sleep centers. A total of 373 subjects with a high risk for moderate to severe OSA were randomized to either unattended, home-based limited channel portable monitoring for diagnosis of OSA followed by unattended auto-titration with continuous positive airway pressure (CPAP), versus a traditional pathway of in-laboratory sleep study and CPAP titration. Given that 3 month outcomes were not inferior for the home arm in acceptance, adherence, and functional improvements, we pursued a cost minimization analysis from the payer perspective. 2011 Medicare price weights were used. Interpretation of home-based CPAP titration is currently not reimbursed by Medicare, so we estimated it as one-third the Medicare reimbursement for interpreting a lab-based sleep study. Per subject costs, as randomized, were $1265 for the lab-based pathway and $927 for the home-based pathway (base case). In the per protocol analysis (patients adherent to CPAP for 3 months), per subject costs were even higher for the lab-based pathway ($1,863 vs. $866). In a sensitivity analysis, even after increasing the Medicare reimbursement for home-based titration studies to 100% that of lab-based studies, per subject costs per protocol were still higher for the lab-based pathway ($1,863 vs. $953). From the payer perspective, there are higher costs incurred within a lab-based versus a home-based diagnostic pathway without superiority in outcomes. The results suggest that the careful use of home-based sleep studies administered by trained personnel at board-certified sleep centers could save money without compromising short term outcomes." @default.
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- W2000261577 date "2012-06-01" @default.
- W2000261577 modified "2023-10-16" @default.
- W2000261577 title "PMD38 Cost Minimization Analysis of a Multi-Site Randomized Clinical Trial of Home-Based Versus Laboratory-Based Testing for the Diagnosis and Treatment of Obstructive Sleep Apnea (HomePAP Study)" @default.
- W2000261577 doi "https://doi.org/10.1016/j.jval.2012.03.378" @default.
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