Public Release:  Home testing and management of OSA reduces costs without impacting clinical outcomes

American Thoracic Society

ATS 2014, SAN DIEGO ─ Home testing of obstructive sleep apnea (OSA) followed by initiation of home treatment with an auto-titrating continuous positive airway pressure (CPAP) device reduced costs compared with in-laboratory testing and titration without negatively impacting clinical outcomes, researchers have shown in a new study presented at the American Thoracic Society International Conference.

"While the use of home testing and initiation of CPAP therapy is increasingly common, studies of its cost-effectiveness are scarce," said lead author Charles W. Atwood, Jr., MD, associate professor of medicine at the University of Pittsburgh School of Medicine and director of the Sleep Disorders Program of the VA Pittsburgh Healthcare System. "In our randomized study, sleep-related costs were substantially lower for patients who underwent home testing and treatment initiation than for those who underwent laboratory testing, and this cost saving was accomplished without sacrificing clinical quality."

The study enrolled 296 subjects, 113 of whom began CPAP at home and 110 of whom began in a laboratory. Assessment with the Functional Outcomes of Sleep Questionnaire, a disease-specific quality of life questionnaire designed to assess the impact of sleep disorders on activities of everyday living and the extent to which these abilities are improved by treatment, showed no significant difference in outcomes between groups.

Costs, categorized as sleep-related, pharmaceutical, laboratory, hospital, and other costs, were measured over 2.75 years. The cost of home testing was significantly lower than the cost of lab testing ($4057 vs $4621, p=0.01), Costs did not significantly differ between groups for the other categories.

"Our study confirms that home testing and treatment initiation for sleep disorders can be accomplished cost-effectively without negatively affecting clinical outcomes," said Dr. Atwood. "These results support the continued use of home management of these disorders."

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* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 55606

Cost-Effectiveness Of Home Management Of Obstructive Sleep Apnea: The Veterans Sleep Apnea Treatment Trial
Type: Scientific Abstract
Category: 16.06 - Sleep Disordered Breathing: Other Outcomes (SRN)
Authors: C.W. Atwood1, S.T. Kuna2, K.C. Little1, S. Hin2, R. Gupta2, I. Gurubhagavatula2, H. Glick3; 1VA Pittsburgh Healthcare System - Pittsburgh, PA/US, 2Philadelphia VA Medical Center - Philadelphia, PA/US, 3University of Pennsylvania - Philadelphia, PA/US

Abstract Body

Rationale: Home sleep apnea testing followed by initiation of CPAP therapy by means of a home auto-titrating CPAP (APAP) trial is an increasingly accepted method of diagnosing and starting therapy for obstructive sleep apnea (OSA). However, there are few data regarding whether such an approach is cost-effective. We performed a randomized clinical trial of home OSA testing followed by a home APAP trial to determine an effective fixed CPAP therapy pressure vs. sleep laboratory testing followed by in-laboratory CPAP titration.

Methods: We conducted a 2 site, randomized, parallel groups study of the functional improvement on CPAP treatment in Veterans with OSA randomized to the standard in-laboratory polysomnography testing (lab group) or home unattended testing (home group). Home testing consisted of an overnight recording with a type 3 portable monitor (Embla) followed by at least 3 nights of using an APAP apparatus (Philips Respironics). Cost data were obtained from case report forms, staff logs, and VA administrative records and were categorized as sleep-related, pharmaceutical, laboratory, hospital, and other costs. We estimated costs per category by use of repeated measure generalized linear models (GLM) with empirically derived links and families. Costs are reported in 2010 dollars and discounted at 3% per year. In sensitivity analysis we also estimated cost differences by use of ordinary least squares regression and GLM with a log link and gamma families to assess whether choice of a statistical model affected our results.

Results: 296 subjects (95% males) were enrolled and 233 were initiated on CPAP (N=110 in-lab; N=113 home). Average age was 51.8±10.4 yr for the lab group and 55.1±10.3 yr for the home group (p=0.02); no other baseline comparisons were significantly different. We found no evidence of clinical inferiority of home testing when assessed by use of the Functional Outcomes of Sleep Questionnaire. However, costs of home testing measured over 2.75 years were $564 lower than lab testing ($4057 vs $4621, p=0.01), while costs for the other 4 categories of cost were not significantly different (p-values ranging between 0.19 and 0.82). Our results were unchanged when we used alternative statistical models to estimate differences in cost.

Conclusion: Home sleep apnea management reduced sleep costs by $564 without increasing other costs or producing clinically inferior outcomes. These data give further support to the use of home sleep apnea management.

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