Reuven H, Schweitzer E, Tarasiuk A
Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Med Decis Making. 2001 Nov-Dec;21(6):451-8. doi: 10.1177/0272989X0102100603.
Obstructive sleep apnea syndrome (OSAS) is a common disorder that affects 2% to 9% of the population. Health care policy makers have noted increased referrals for sleep studies.
In this article, the authors conduct a cost-effectiveness analysis to determine the optimal technology for the diagnosis of OSAS using polysomnography (PSG) or partial sleep monitoring (PSM).
The target population was a hypothetical cohort of patients suspected of having OSAS. A 2-level decision tree wasformulated that reflects all possible steps of OSAS diagnosis and therapy. The method represents a comprehensive strategy to determine which of the 2 systems-PSG or PSM-has cost advantages. The financial and operational aspects of OSAS diagnosis and therapy were analyzed. A sensitivity analysis was performed over all uncertain parameters (i.e., diagnostic agreement, data loss, and referral to therapy).
Unattended at-home sleep monitoring was the most expensive method. The combination of 1:2 PSG and attended PSM strategy was the optimal strategy with respect tofinancing and operations. Compared to the PSG-only strategy, this combination may lead to a 10% reduction of the annual expenditure.
This study provides proof of concept (under a wide range of sensitivity assumptions) that the cost of sleep study techniques can be modeled. It rejects the assumption that athome portable sleep monitoring is cost advantageous. The combination of PSG and attended PSM OSAS is the most cost-effective approach to sleep evaluation.
阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见疾病，影响着2%至9%的人口。医疗保健政策制定者已注意到睡眠研究的转诊量有所增加。
在本文中，作者进行了一项成本效益分析，以确定使用多导睡眠图（PSG）或部分睡眠监测（PSM）诊断OSAS的最佳技术。
目标人群是一组疑似患有OSAS的假设队列患者。制定了一个两级决策树，反映了OSAS诊断和治疗的所有可能步骤。该方法代表了一种全面的策略，以确定PSG或PSM这两种系统中哪一种具有成本优势。分析了OSAS诊断和治疗的财务和运营方面。对所有不确定参数（即诊断一致性、数据丢失和转诊治疗）进行了敏感性分析。
无人值守的家庭睡眠监测是最昂贵的方法。1:2 PSG和有人值守的PSM策略相结合在融资和运营方面是最佳策略。与仅采用PSG的策略相比，这种组合可能会使年度支出降低10%。
本研究提供了概念验证（在广泛的敏感性假设下），即睡眠研究技术的成本可以进行建模。它否定了家庭便携式睡眠监测具有成本优势的假设。PSG和有人值守的PSM用于OSAS相结合是睡眠评估最具成本效益的方法。
