Many experts in the field of sleep medicine have stated that making the diagnosis of obstructive sleep apnea is not difficult, and yet the National Commission on Sleep Disorders reported that approximately 90% to 95% of all sleep apnea patients remain undiagnosed? There is now compelling evidence from several studies that this increases the dollar cost burden of health care.
In a pioneering study published in 1996, Dr. Meir Kryger and his team at the University of Manitoba concluded that in the 2 years prior to their diagnosis, patients with severe obstructive sleep apnea (OSA) were heavy users of health care resources and incurred costs that were twice that of the general population. For example, the OSA group had 251 nights in the hospital as compared to 90 nights for the matched control group! During that same period, physician claims for the OSA group totaled over $82,000 while the control group was only $41,018.
In a second study published in 1998, Dr. Kryger extended his analysis to include the ten years prior to their diagnosis and found that untreated obstructive sleep apnea patients utilize approximately twice the healthcare resources as the matched controls! In a study of 181 patients at the University of Manitoba in Winnipeg, he found that the average cost for physician visits for the undiagnosed group was $3,972 per patient, whereas, the average cost for physician visits in the control group from the general population, was $1,969 per patient (49.6% less). In addition, the undiagnosed OSA patients had average hospitalization expenses of $6,176 per patient. By contrast, the control group had averaged $3,734 per patient of hospitalization expenses. Their costs were lower by more than 60%!
In a follow-up study published in 1999, Dr. Kryger and his group studied clinical data from 344 OSA patients during the first years after being diagnosed and treated. Hospital stays for the patient's who were diagnosed and treated decreased from 1.25 days per patient per year one year prior to diagnosis, to .53 days per patient per year. For the same group, the average yearly cost per patient of physician visits one year prior to diagnosis was about $500. Two years after diagnosis and treatment, it had dropped to about $390. Their conclusion was that "treatment of OSAS resulted in a significant reduction in health care utilization in the group adhering to treatment while the group not adhering to treatment did not have any significant change".
These are very exciting and promising results. Further documentation should be vigorously pursued to establish beyond a shadow of a doubt that treating obstructive sleep apnea reduces health care costs. However, we know enough to call for a national effort to achieve early diagnosis and treatment which will save patients years of personal agony and avoid the costs they would ordinarily incur.
References
Health Care Utilization in Males with OSAS Two years after Diagnosis and Treatment by Bahamman et. al. In Sleep 1999; 22: 740-747
Utilization of Health Care Services in Patients with Severe Obstructive Sleep Apnea by Kryger et. al. In Sleep 1996; 19: S111-S116
OSA Patients Use More Health Care Resources Ten Years Prior to Diagnosis by Kryger, et al; Sleep Research Online 1(1): 71-74, 1998.
Additional Reading
The Medical Cost of Undiagnosed Sleep Apnea by Kapur et. el. Sleep 1999; 22: 749-754.
Economic Implications of the Diagnosis of OSA by Pack et. al., Annals of Internal Medicine 1999; 130:533-534
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