Cost-Benefit Analysis of Polysomnography versus Clinical Assessment Score-15 (CAS-15) for Treatment of Pediatric Sleep-Disordered Breathing

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.