An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea

Study objectivesWe conducted an economic analysis of the HomePAP study, a multicenter randomized clinical trial that compared home-based versus laboratory-based testing for the diagnosis and management of obstructive sleep apnea (OSA).DesignA cost-minimization analysis from the payer and provider perspectives was performed, given that 3-mo clinical outcomes were equivalent.SettingSeven academic sleep centers.ParticipantsThere were 373 subjects at high risk for moderate to severe OSA.InterventionsSubjects were randomized to either home-based limited channel portable monitoring followed by unattended autotitration with continuous positive airway pressure (CPAP), versus a traditional pathway of in-laboratory sleep study and CPAP titration.Measurements and resultsFrom the payer perspective, per subject costs for the laboratory-based pathway were $1,840 (95$1,660, $2,015) compared to$1,575 (95% CI $1,439,$1,716) for the home-based pathway under the base case. Costs were $264 (95$39, $496, P = 0.02) in favor of the home arm. From the provider perspective, per subject costs for the laboratory arm were$1,697 (95% CI $1,566,$1,826) compared to $1,736 (95$1,621, $1,857) in the home arm, for a difference of$40 (95% CI -$213,$142, P = 0.66) in favor of the laboratory arm under the base case. The provider operating margin was $142 (95$85, 202,P < 0.01) in the laboratory arm, compared to a loss of -161 (95% CI -$202, -$120, P &lt; 0.01) in the home arm.ConclusionsFor payers, a home-based diagnostic pathway for obstructive sleep apnea with robust patient support incurs fewer costs than a laboratory-based pathway. For providers, costs are comparable if not higher, resulting in a negative operating margin.Clinicaltrialsgov identifierNCT00642486