Cost‐Benefit Analysis of Polysomnography versus Clinical Assessment Score‐15 (CAS‐15) for Treatment of Pediatric Sleep‐Disordered Breathing. (23rd August 2013)

• Record Type: Journal Article
• Authors: Konka, Anita; Weedon, Jeremy; Goldstein, Nira A.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 149(2013)Supplement 2
• Page Start: P242
• Page End: P242
• Publication Date: 2013-08-23
• Subjects: Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813496044a303
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: Determine the cost of medical care using the CAS‐15 versus polysomnography for children with sleep‐disordered breathing in terms of benefit measured by change in quality‐of‐life and behavior scores. Methods: 93 patients from our original CAS‐15 study were included. Four clinical measures were used (Child Behavior Checklist [CBCL], OSA‐18, Pediatric Quality of Life Inventory [PedsQL], and AHI). Payment data were obtained for outpatient office visits, sleep laboratory admissions, and hospital admissions for T&A. Cost benefit analysis was performed between initial and final visits for two clinical pathways. In pathway 1, all children had polysomnography (PSG); those with positive studies were referred for T&A. In pathway 2, children with CAS‐15 >32 were referred for T&A regardless of PSG. Treatment costs were calculated in each pathway. Paired t‐test compared intra‐subject mean total cost (pathway 1 vs. pathway 2). Further analyses computed a change score for the 4 clinical measures (follow‐up minus baseline), producing 4 cost‐benefit ratios for each pathway. Paired t‐tests compared the mean of these ratios between the two 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 $1172.06USD [SE $214.30] in pathway 2 versus pathway 1 ( P <.001). CAS‐15 is also cost‐beneficial versus PSG in 3 of 4 clinical measures (CBCL [ P =. 008], OSA‐18 [ P <. 001], AHI [ P <. 001]). Conclusions: We present evidence that in 3 of 4 clinical measures evaluated, CAS‐15 criterion is cost‐effective over PSG in the treatment of pediatric sleep disordered breathing.