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Titre : | Cost-Benefit Analysis From the Payors Perspective for Screening and Diagnosing Obstructive Sleep Apnea During Inpatient Rehabilitation for Moderate to Severe TBI (2020) |
Auteurs : | Risa Nakase-Richardson ; Jeanne M. Hoffman ; Ulysses J. Magalang ; Emily Almeida ; Daniel J. Schwartz ; Leah Drasher-Phillips ; Jessica M. Ketchum ; John Whyte ; Jennifer A. Bogner ; Clara E. Dismuke-Greer |
Type de document : | Article : Périodique |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 101, n° 9, 2020) |
Article en page(s) : | p. 1497-1508 |
Note générale : | https://doi.org/10.1016/j.apmr.2020.03.020 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Analyse coût-bénéfice ; Encephale ; Plaies et blessures ; Polysomnographie ; Réadaptation ; Syndromes d'apnées du sommeil |
Résumé : |
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 payors 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 vehiclerelated 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. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999320302288#! |