Cost-benefit analysis from the payor's perspective for the screening and diagnosing OSA during inpatient rehabilitation for moderate to severe TBI.

ABSTRACT Objective To describe the cost-benefit of four different approaches to screening for sleep apnea in a cohort of participants with moderate to severe TBI receiving inpatient rehabilitation from the payor’s perspective. Design A cost-benefit analysis of phased approaches to sleep apnea diagnosis. Setting Six TBI Model System Inpatient Rehabilitation Centers Participants Trial data from 214 participants were used in analyses (mean age 44 [SD 18], 82% male, 75% white, with primarily motor-vehicle related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8 (SD 5). Intervention Not applicable. Main Outcome Cost-benefit Results At AHI ≥15 (34%), phased modeling approaches using screening measures (STOPBANG [-$5,291], MAPI [-$5,262]) resulted in greater cost savings and benefit relative to the portable diagnostic approach (-$5,210) and initial use of laboratory-quality polysomnography (-$5,011). Analyses at AHI ≥5 (70%) revealed the initial use of portable testing (-$6,323) relative to the screening models (MAPI [-$6,250], STOPBANG [-$6,237) and initial assessment with polysomnography (-$5,977) resulted in greater savings and cost effectiveness. Conclusion The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-beneficial approach varying by incidence of OSA.