A cost-minimization study of telemedicine - The case of telemonitored polysomnography to diagnose obstructive steep apnea syndrome

Objectives: In a context where sleep laboratories are overwhelmed by a grow ing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient s ubstitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hps g) and telemonitored polysomnography (TMpsg), a cost minimization study was performed. Methods: In a crossover trial, 99 patients underwent on two consecutive nig hts TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TM psg and Hpsg was performed. The risks to adopt home strategy or telemonitor ed strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed. Results: The recording was considered to be ineffective in 11.2% of TMpsg ( 95% Cl, 4.9-17.4) and in 23.4% (95% Cl, 19.12-27.68) of Hpsg. The effective ness differential was 12.2% (95% Cl, 1.8-22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach th e diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of T Mpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 less than or equal to Hc/TMc less than or equal to 0.97, the choice of TMpsg would be a mbiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63). Conclusion: Unless some specific geographical situations generate significa nt transport costs, the implementation of a strategy based on unattended po lysomnography at home is cost-saving compared to a telemonitoring strategy.