Cost Justification For Diagnosis and Treatment Of Obstructive Sleep Apnea

The American Academy of Sleep Medicine (AASM), the professional organization for sleep medicine professionals, recently released a position paper on "Cost Justification for Diagnosis and Treatment of Obstructive Sleep Apnea".

Published in the December 15, 2000 issue of the journal Sleep, the statement lays out the evidence on this issue.

Obstructive Sleep Apnea Syndrome (OSAS) was first defined approximately 30 years ago. Since that time, the growing recognition of the disorder has caused a substantial increase in health care costs related to the diagnosis and treatment of all forms of sleep-disordered breathing (SDB).

It is well recognized that treating sleep disordered breathing has numerous, well-established health benefits. However, there is not general recognition of the cost-savings to the health care insurance industry when SDB is diagnosed and treated. The new AASM position paper reviews the evidence that supports the cost justification of detecting and treating SDB.

Key points highlighted in the paper include:

• Untreated SDB is associated with increased risk of morbidity (illness) and mortality (death). Mortality is related in a graded fashion to the severity of the SDB and is also influenced by co-morbidity (the presence of co-existing illnesses).
• Untreated SDB is associated with both causal and contributing roles in the development of co-morbidities such as hypertension and cardiovascular events.
• Untreated SDB has been linked to increased risk of motor vehicle accidents.
• Before treatment for OSA, patients consume more health cost dollars and time than matched control subjects. Studies have indicated untreated sleep apnea patients use as many as 2.5 - 3 times as many hospital days and twice the physician costs.
• The only study to look at post-treatment costs found that physician costs decreased 33% after treatment, and hospital days dropped by 50% in patients adhering to treatment.
• There are cost advantages to including sleep-monitoring procedures (such as polysomnograms) in the diagnosis of SDB. A recent study demonstrated savings of around $10,000 per quality-adjusted life year gained, while the cost of polysomnography compares favorably with other outpatient diagnostic tests.

The paper concludes: "Diagnosis and treatment of sleep-disordered breathing (SDB) are justifiable on the basis of short-term and lifetime cost savings. Diagnosis and treatment of SDB are more efficiently accomplished by physician evaluation and sleep monitoring rather than physician evaluation alone."