Cost-Effectiveness of Sleep Apnea Diagnosis and Treatment in Hospitalized Persons With Moderate to Severe Traumatic Brain Injury.
Athanasios Tsalatsanis, Clara Dismuke-Greer, Ambuj Kumar and 6 others
PMID 38652666WHAT IT FOUND
For hospitalized people with moderate to severe traumatic brain injury, phased screening, testing, and treatment for sleep apnea was more cost effective than usual care or treating everyone.
This was a cost model, not a patient outcome trial.
Key findings
01Phased screening and testing before treatment was more cost effective than usual care or treating everyone, across both mild-to-severe and moderate-to-severe sleep apnea.
02For moderate-to-severe sleep apnea, the STOP-Bang to portable test to lab test pathway cost $1435 and had 98% modeled effectiveness.
03Usual care with no screening, testing, or treatment was the most expensive approach.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study is a cost-effectiveness model, not a trial of patient outcomes, so it does not show that sleep apnea treatment improves cognition, function, pain, or recovery. The model assumed laboratory sleep testing had 95% sensitivity and specificity, plus or minus 5%, because no published values were available. It assumed treatment was successful and did not measure whether patients used CPAP as recommended. Cost savings were based on general population economic modeling, which may not apply to people with traumatic brain injury. The analysis was from the payor perspective, so it may not capture provider, patient, or system burdens. The model used data from hospitalized traumatic brain injury rehabilitation patients, so results may not apply to other traumatic brain injury or sleep apnea populations. Usual care costs may be higher for people with traumatic brain injury who need inpatient rehabilitation because they often have multiple health conditions.
Declared interests
The authors declared no conflicts of interest. The article is categorized as supported by U.S. government and NIH extramural research.
The easy way to misread this
Do not read the cost-effective pathway as proof that treating sleep apnea improves traumatic brain injury recovery. The paper modeled costs and treatment allocation, not patient outcomes, and it assumed treatment was successful without measuring adherence.