Abstract
Objective
To describe the cost benefit of 4 different approaches to screening for sleep apnea
in a cohort of participants with moderate to severe traumatic brain injury (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 participants (N=214) were used in analyses (mean age 44±18y, 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±5).
Intervention
Not applicable.
Main Outcome
Cost benefit.
Results
At apnea-hypopnea index (AHI) ≥15 (34%), phased modeling approaches using screening
measures (Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference,
and Gender [STOPBANG] [–$5291], Multivariable Apnea Prediction Index MAPI [–$5262])
resulted in greater cost savings and benefit relative to the portable diagnostic approach
(–$5210) and initial use of laboratory-quality polysomnography (–$5,011). Analyses
at AHI≥5 (70%) revealed the initial use of portable testing (–$6323) relative to the
screening models (MAPI [–$6250], STOPBANG [–$6237) and initial assessment with polysomnography
(–$5977) resulted in greater savings and cost-effectiveness.
Conclusions
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.
Keywords
List of abbreviations:
AHI (apnea-hypopnea index), AHRQ (Agency for Healthcare Research in Quality), MAPI (Multivariable Apnea Prediction Index), OSA (obstructive sleep apnea), PSG (polysomnography), STOPBANG (Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 03, 2020
Footnotes
Supported by the Patient-Centered Outcomes Research Institute (award no. CER-1511-33005); the VHA Central Office VA TBI Model Systems Program of Research; and a subcontract from General Dynamics Information Technology (no. W91YTZ-13-C-0015; HT0014-19-C-0004) from the Defense and Veterans Brain Injury Center and National Institute on Disability, Independent Living, and Rehabilitation Research (NDSC grant no. 90DPTB00070 [Craig Hospital], 90DP0084 [Craig Hospital NDSC], 90DPTB0013-01-00 [Baylor Scott & White], 90DPTB0008 [University of Washington], 90DPT80004-02 [Moss Rehabilitation], 90DPTB0001 [Ohio State University]). The statements presented in this publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its Board of Governors, or its Methodology Committee.
Clinical Trial Registration No.: NCT03033901.
Disclosures: Dr Magalang receives funding from Hill-Rom. The other authors have nothing to report.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
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- CorrectionArchives of Physical Medicine and RehabilitationVol. 102Issue 3
- PreviewThe article by Nakase-Richardson et al, Cost-Benefit Analysis From the Payor’s Perspective for Screening and Diagnosing Obstructive Sleep Apnea During Inpatient Rehabilitation for Moderate to Severe TBI, published in Archives of Physical Medicine and Rehabilitation 2020;101(9):1497-1508 (DOI: https://doi.org/10.1016/j.apmr.2020.03.020 ), contained an error in the funding information. Patient-Centered Outcomes Research Institute® (PCORI®) Award (CER-1511-33005) was not the source of funding for this analysis.
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