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Cost-utility analysis of a tiered diagnostic approach combining a screening model and polysomnography in pediatric
Shenglong Xu1,2,3, Yanru Li1,2,3, Demin Han1,2,3,4
1Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Insights
A new screening model combined with polysomnography (PSG) offers a cost-effective strategy for diagnosing pediatric obstructive sleep apnea (OSA). This tiered approach improves diagnostic accuracy and efficiency in managing childhood OSA.
Area of Science:
- Pediatric Sleep Medicine
- Health Economics
- Diagnostic Strategy Development
Background:
- Obstructive sleep apnea (OSA) is prevalent in children.
- Polysomnography (PSG) is the standard diagnostic tool but is costly and has limited availability.
- Cost-effective diagnostic alternatives are needed for pediatric OSA.
Purpose of the Study:
- To develop and evaluate a cost-effective diagnostic strategy for pediatric obstructive sleep apnea (OSA).
- To compare the cost-utility of different diagnostic pathways, including PSG alone, a screening model alone, and a combined screening model-PSG approach.
Main Methods:
- Retrospective analysis of 690 children with suspected OSA.
- Development of machine learning-based screening models.
- Cost-utility analysis using incremental net monetary benefit to compare diagnostic strategies.
Main Results:
- The combined screening model-PSG strategy achieved 100% sensitivity and 99.2% specificity.
- This integrated approach was the most cost-effective, with a utility of 0.9554 at CNY 4,463.36.
- The combined strategy demonstrated a positive incremental net monetary benefit of CNY 34.22.
Conclusions:
- Integrating a screening model as a triage tool significantly enhances the cost-effectiveness of diagnosing pediatric OSA.
- This tiered diagnostic approach optimizes resource allocation and improves patient management for childhood OSA.
Study Objectives:
Obstructive sleep apnea (OSA) is a common disorder in the pediatric population, primarily diagnosed through polysomnography (PSG). However, PSG can be expensive and is often limited in availability. This study aimed to develop a cost-effective diagnostic strategy by integrating a screening model with PSG.
Methods:
A retrospective analysis was conducted on children suspected of OSA. Screening models were initially constructed with machine learning techniques. Cost-utility analyses compared 3 diagnostic strategies: (1) PSG alone, (2) the screening model alone, and (3) the screening model-PSG combined, in the discovery and validation cohorts. Cost-utility was measured using the incremental net monetary benefit.
Results:
A total of 690 children were included. The logistic regression model using age, tonsil scale, OSA questionnaire-18 questions 1 and 2, and oxygen desaturation index 3% predicted OSA with an area under the curve of 0.91. In the cost-utility analysis, the "PSG alone" strategy, as the baseline, was the most beneficial (utility 0.9557) at Chinese yuan (CNY) 4,523.98. The "screening model alone" had 91.6% sensitivity and 59.3% specificity, offering lesser value (utility 0.9337) at CNY 6,071.51 (incremental net monetary benefit CNY -3,966.43) when compared to "PSG alone." The "screening model-PSG combined" strategy increased sensitivity to 100%, specificity to 99.2%, and utility to 0.9554 at CNY 4,463.36, establishing it as the most cost-effective option with an incremental net monetary benefit of CNY 34.22. One-way sensitivity analyses and adaptation to United States cost parameters confirmed the robustness of these results.
Conclusions:
Using the screening model as a triage tool for PSG enhances the cost-effectiveness of pediatric OSA management.
Citation:
Xu S, Li Y, Han D. Cost-utility analysis of a tiered diagnostic approach combining a screening model and polysomnography in pediatric obstructive sleep apnea. J Clin Sleep Med. 2025;21(4):655-665.
