Cost-Effectiveness of Sleep Apnea Diagnosis and Treatment in Hospitalized Persons With Moderate to Severe Traumatic Brain Injury

Athanasios Tsalatsanis ¹, Clara Dismuke-Greer , Ambuj Kumar

⁰Author Affiliations: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida (Dr Tsalatsanis and Dr Kumar); Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California (Dr Dismuke-Greer); Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington (Dr Hoffman); Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota (Dr Monden); The Ohio State University Wexner Medical Center, Columbus, Ohio (Dr Magalang); and Medicine Service (Dr Schwartz) Mental Health and Behavioral Science Service (Dr Martin), and Polytrauma TBI Rehabilitation (Dr Nakase-Richardson), James A. Haley Veterans' Hospital, Tampa, Florida.

The Journal of Head Trauma Rehabilitation +

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April 23, 2024

View abstract on PubMed

Summary

Diagnosing and treating obstructive sleep apnea (OSA) in traumatic brain injury (TBI) patients during inpatient rehabilitation is cost-effective. Phased approaches using screening and diagnostic tools are more effective and less costly than usual care.

Area Of Science

Neuroscience
Sleep Medicine
Health Economics

Background

Obstructive sleep apnea (OSA) is prevalent in patients with traumatic brain injury (TBI).
Effective diagnosis and treatment of OSA are crucial for optimizing TBI rehabilitation outcomes.
Current diagnostic and treatment strategies for OSA in TBI patients during inpatient rehabilitation require cost-effectiveness evaluation.

Purpose Of The Study

To assess the cost-effectiveness of various approaches to diagnose and treat OSA in patients with TBI during inpatient rehabilitation.
To compare the effectiveness and cost of different OSA diagnostic and treatment strategies against usual care.

Main Methods

Decision tree analysis was employed to evaluate cost-effectiveness.
Data were sourced from the C-SAS clinical trial (NCT03033901) involving an inpatient rehabilitation TBI cohort.
Six strategies were assessed: usual care, phased diagnostic testing, STOP-Bang questionnaire screening, MAPI screening, universal laboratory testing, and universal treatment.

Main Results

Phased approaches incorporating screening and diagnostic tools demonstrated superior effectiveness in OSA diagnosis and treatment allocation for mild to severe and moderate to severe OSA.
Usual care was found to be more expensive and less effective compared to all other evaluated approaches for both mild to severe and moderate to severe OSA.
Sensitivity analysis was conducted to address uncertainty in the findings.

Conclusions

Diagnosing and treating OSA in TBI patients during inpatient rehabilitation is a cost-effective strategy.
Phased diagnostic and treatment approaches offer better value compared to usual care for OSA management in TBI patients.