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Cost-minimisation analysis of polysomnography and pulse oximetry in a risk stratification protocol for paediatric
Seraphina Key1, Clemente Chia1,2, Gillian Nixon3,4
1Department of Otolaryngology, Head & Neck Surgery, Monash Health, Melbourne, Victoria, Australia.
Insights
Pre-operative overnight oximetry for paediatric adenotonsillectomy (AT) is cost-effective. This method aids in stratifying risk for obstructive sleep apnoea (OSA) patients, potentially lowering overall healthcare costs despite a small initial investment.
Area of Science:
- Health Economics
- Pediatric Otolaryngology
- Sleep Medicine
Background:
- Severe obstructive sleep apnoea (OSA) increases post-operative respiratory risks in pediatric adenotonsillectomy (AT).
- Pre-operative risk stratification using polysomnography or overnight oximetry is crucial for managing these risks.
Purpose of the Study:
- To analyze the economic costs of using polysomnography versus overnight oximetry for pre-operative risk stratification in pediatric AT.
- To supplement existing research on the efficacy of these protocols in predicting respiratory complications.
Main Methods:
- A cost-minimisation analysis was conducted on 1801 pediatric patients undergoing AT for OSA.
- Decision analysis modelling using probability trees estimated pre- and peri-operative costs.
- A hypothetical 'no investigation' model was included for comparison.
Main Results:
- The total cost per patient for AT with pre-operative oximetry was AUD4181.34 and with polysomnography was AUD5013.99.
- Both investigation methods were more expensive than a hypothetical no-investigation model (AUD3958.98).
Conclusions:
- Overnight oximetry as a pre-operative triage tool incurs a small additional cost.
- This cost is balanced by reduced care costs in lower-acuity settings for low-risk patients.
- Oximetry supports peri-operative risk stratification for pediatric AT from a financial standpoint.
Background:
Severe obstructive sleep apnoea (OSA) is associated with increased risk of respiratory compromise in the post-operative period following adenotonsillectomy (AT). This study analyses the economic cost of polysomnography or overnight oximetry as part of pre-operative risk stratification in paediatric AT, supplementing previously published research demonstrating the efficacy of this protocol in predicting respiratory complications.
Methods:
This cost-minimisation analysis examines costs associated with pre-operative overnight oximetry and polysomnography in triaging paediatric patients older than 2 years old, with no major comorbidities except for OSA, undergoing AT for OSA (n = 1801) to either a secondary or quaternary Australian hospital. Decision analysis modelling via probability trees were utilized to estimate pre- and peri-operative costs. A third hypothetical 'no investigation' model based upon conducting all AT at a secondary hospital was performed. Costs are derived from the financial year 2020-2021, censored at discharge.
Results:
The total cost per patient of AT including pre-operative investigations of oximetry and polysomnography, and associated inpatient costs, were AUD4181.34 and 5013.99 respectively. This is more expensive compared to a hypothetical no-investigation model (AUD3958.98).
Conclusion:
Within the scope of this partial economic evaluation, this study finds a small additional cost for a model of care involving overnight oximetry as a pre-operative triage tool, balanced by the reduced cost of care in a lower acuity centre for low-risk patients and potential high cost of complications if all children are treated in a low acuity centre. This supports oximetry in peri-operative risk stratification for paediatric AT from a financial perspective.
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