Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Sleep Center, The Children's Hospital of Philadelphia, Philadelphia, PA.
Sleep. 2017 Feb 1;40(2). doi: 10.1093/sleep/zsw051.
Continuous positive airway pressure (CPAP) is effective in treating obstructive sleep apnea in children, but adherence to therapy is low. Our center created an intensive program that aimed to improve adherence. Our objective was to estimate the program's efficacy, cost, revenue and break-even point in a generalizable manner relative to a standard approach.
The intensive program included device consignment, behavioral psychology counseling, and follow-up telephone calls. Economic modeling considered the costs, revenue and break-even point. Costs were derived from national salary reports and the Pediatric Health Information System. The 2015 Medicare reimbursement schedule provided revenue estimates.
Prior to the intensive CPAP program, only 67.6% of 244 patients initially prescribed CPAP appeared for follow-up visits and only 38.1% had titration polysomnograms. In contrast, 81.4% of 275 patients in the intensive program appeared for follow-up visits (p < .001) and 83.6% had titration polysomnograms (p < .001). Medicare reimbursement levels would be insufficient to cover the estimated costs of the intensive program; break-even points would need to be 1.29-2.08 times higher to cover the costs.
An intensive CPAP program leads to substantially higher follow-up and CPAP titration rates, but costs are higher. While affordable at our institution due to the local payer mix and revenue, Medicare reimbursement levels would not cover estimated costs. This study highlights the need for enhanced funding for pediatric CPAP programs, due to the special needs of this population and the long-term health risks of suboptimally treated obstructive sleep apnea.
持续气道正压通气（CPAP）治疗儿童阻塞性睡眠呼吸暂停有效，但治疗依从性较低。本中心创建了一项强化计划，旨在提高治疗依从性。我们的目标是在可推广的范围内，相对于标准方法，估计该计划的疗效、成本、收入和收支平衡点。
强化计划包括设备寄售、行为心理学咨询和随访电话。经济模型考虑了成本、收入和收支平衡点。成本来自国家工资报告和儿科健康信息系统。2015 年医疗保险报销时间表提供了收入估计。
在强化 CPAP 计划之前，仅 244 名最初接受 CPAP 治疗的患者中有 67.6%接受了随访，仅有 38.1%进行了滴定多导睡眠图检查。相比之下，强化计划的 275 名患者中有 81.4%接受了随访（p<0.001），83.6%进行了滴定多导睡眠图检查（p<0.001）。医疗保险报销水平不足以支付强化计划的估计成本；收支平衡点需要提高 1.29-2.08 倍才能覆盖成本。
强化 CPAP 计划可显著提高随访和 CPAP 滴定率，但成本更高。由于当地支付者组合和收入，该计划在我们机构负担得起，但医疗保险报销水平无法覆盖估计成本。这项研究强调了需要为儿科 CPAP 计划提供更多资金，因为该人群有特殊需求，并且阻塞性睡眠呼吸暂停治疗不足会带来长期健康风险。
