Economic Assessment of 4 Approaches to the Diagnosis and Initial Treatment of Sleep Apnea

Dawn M. Bravata, Nancy Lightner, H. Klar Yaggi, Edward J. Miech

Research output: Contribution to journalArticle

1 Scopus citations


BACKGROUND: A dilemma faced by health-care administrators is that need greatly outstrips capacity for diagnosing and treating sleep apnea, with such decisions carrying significant economic consequences. Our objective was to develop an economic model to estimate the relative costs of 4 approaches for diagnosis and initial treatment of sleep apnea.

METHODS: The analysis consisted of developing a mathematical model depicting possible diagnostic and treatment approaches to the care of patients with sleep apnea; developing 4 clinical scenarios to describe distinct approaches to the management of sleep apnea patients (in-laboratory, unattended, direct-to-autotitrating PAP [auto-PAP], and mixed); and identifying costs associated with each scenario. We created a hypothetical cohort of 1,000 patients with 85% prevalence of sleep apnea to generate cost estimates.

RESULTS: The driver of per-patient costs was the total number of sleep studies, which varied widely across scenarios: from 425 for the direct-to-auto-PAP approach to 1,441 in the unattended approach. The scenarios also differed in per-patient costs: Per-patient costs excluding facility startup costs were $456 for direct-to-auto-PAP, $913 for in-laboratory, $991 for mixed, and $1,090 for unattended.

CONCLUSIONS: Approaches to diagnosing and treating sleep apnea that emphasized early application of auto-PAP had lower per-patient costs.

Original languageEnglish (US)
Pages (from-to)50-61
Number of pages12
JournalRespiratory care
Issue number1
StatePublished - Jan 1 2018


  • economic model
  • health services research
  • health-care capacity
  • positive airway pressure
  • sleep apnea
  • unattended polysomnography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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