Cost‐benefit Analysis of Polysomnography versus Clinical Assessment Score‐15 (CAS‐15) for Treatment of Pediatric Sleep‐disordered Breathing. (16th June 2014)

• Record Type: Journal Article
• Authors: Konka, Anita; Weedon, Jeremy; Goldstein, Nira A.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 151:Number 3(2014:Sep.)
• Page Start: 484
• Page End: 488
• Publication Date: 2014-06-16
• Subjects: pediatric sleep disordered breathing -- cost‐benefit analysis -- cost -- polysomnography -- PSG -- obstructive sleep apnea -- OSA -- CAS‐15 -- clinical assessment score; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599814536844
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objective: To determine the cost of medical care using the Clinical Assessment Score‐15 (CAS‐15) scale versus polysomnography (PSG) for children with sleep‐disordered breathing in terms of benefit. Study Design: Cost‐benefit analysis. Setting: Hospital‐based pediatric otolaryngology practice. Subjects and Methods: Ninety‐three patients from our original CAS‐15 study were included. Four clinical measures were used and payment data were obtained. Cost‐benefit analysis was performed for 2 clinical pathways. In pathway 1, all children had PSG; those with positive studies were referred for adenotonsillectomy. In pathway 2, children with CAS‐15 ≥ 32 were referred for adenotonsillectomy regardless of PSG. Paired t test compared intrasubject mean total cost (pathway 1 vs pathway 2). Further analyses computed a change score for the clinical measures (follow‐up minus baseline); these were divided by estimated treatment cost, producing 4 cost‐benefit ratios for each pathway. Paired t tests compared the mean of these ratios between the pathways. Results: Of 65 PSG+ (15 CAS–), 54 underwent surgery; of 28 PSG– (17 CAS–), 7 underwent surgery. Model estimated costs demonstrate a mean cost benefit of $US1172 (SE = $214) for pathway 2 versus pathway 1 ( P <. 001). CAS‐15 is also cost‐beneficial versus PSG in 3 of 4 clinical measures (Child Behavior Checklist total problem T score, P =. 008, mean OSA‐18 survey score, P <. 001, apnea hypopnea index, P <. 001). Conclusions: We present evidence that a CAS‐15–based treatment decision criterion is superior to PSG in terms of monetary cost and in benefit per unit cost for 3 of 4 clinical measures evaluated.