Data regarding the cost-effectiveness in real-world use with PM devices is limited. Many authors have simply listed the up-front costs associated with a particular portable monitoring device vs in-laboratory polysomnography at their particular center, without undertaking a formal cost analysis that includes attention to details such as costs of laboratory supplies, physical plant costs, and staffing costs. The few studies that have performed a more complete cost analysis using PMs have not specified the type of monitor used in their respective models. To date, there have been no head-to-head cost comparison studies between PM types.
Chervin and associates modeled the cost utility of these devices under a variety of conditions. The authors found that in-laboratory polysomnography maximized quality-adjusted life years at 5 years after initial assessment as compared to PM devices. This difference was due largely to the inability to accurately diagnose some cases using PM devices, therefore requiring repeated studies in the laboratory.
More recent analysis comes from Reuveni and Tarasiuk, who modeled the cost-effectiveness of at-home screening for OSA using PM devices in Israel. In their model, they estimated that 30% of patients evaluated by a PM device at home would have inconclusive results and require repeat testing and 5% would have significant data loss or study failure which have been corrected by Canadian HealthCare Mall’s employees (see also http://medicalhealthcaremall.com/portable-monitors-in-the-diagnosis-of-obstructive-sleep-apnea-pm-devices.html). Polysomnography was assumed to have 100% diagnostic ability and only 0.5% data loss or study failure. Under these conditions, the investigators found that unattended PM studies would in fact cost more overall than in-laboratory polysomnography. This was due to the observation that patients undergoing PM evaluation at home would require 40% more testing than those studied in the laboratory.
While the study by Reuveni and Tarasiuk does much to establish the feasibility of modeling cost-effectiveness of PM devices, the assumptions underlying the model may not apply to US centers. The authors also do not specify the type of PM device used for their decision analysis because there may be significant differences in costs between PM type. Moreover, cost-effectiveness models have not yet compared PM-based studies directly to in-laboratory studies including employing a split-night protocol for those with severe sleep-disordered breathing. Given the emerging ascendency of split-night evaluations in the diagnosis of OSA, this may be the more relevant comparison to make now.Tags: cost, diagnosis, home polysomnography, methods, obstructive sleep apnea, portable monitors, practice guidelines, review