Sleep. 1999 Sep 15;22(6):749-55.
The medical cost of undiagnosed sleep apnea.
Kapur V, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, Psaty BM.
Source
Department of Medicine, University of Washington, Seattle 98195, USA.
Abstract
Obstructive sleep apnea is an under-diagnosed, but common disorder with serious adverse
consequences. Cost data from the year prior to the diagnosis of sleep-disordered breathing in a
consecutive series of 238 cases were used to estimate the potential medical cost of undiagnosed
sleep apnea and to determine the relationship between the severity of sleep-disordered breathing
and the magnitude of medical costs. Among cases, mean annual medical cost prior to diagnosis
was $2720 versus $1384 for age and gender matched controls (p<0.01). Regression analysis
showed that the reciprocal of the apnea hypopnea index among cases was significantly related to
log-transformed annual medical costs after adjusting for age, gender, and body mass index
(p<0.05). We conclude that patients with undiagnosed sleep apnea had considerably higher
medical costs than age and sex matched individuals and that the severity of sleep-disordered
breathing was associated with the magnitude of medical costs. Using available data on the
prevalence of undiagnosed moderate to severe sleep apnea in middle-aged adults, we estimate
that untreated sleep apnea may cause $3.4 billion in additional medical costs in the U.S. Whether
medical cost savings occur with treatment of sleep apnea remains to be determined.
PMID:
10505820
[PubMed - indexed for MEDLINE]
Monaldi Arch Chest Dis. 2000 Oct;55(5):404-10.
Sleep apnoea syndrome: the health economics point of view.
Rodenstein DO.
Source
Service de Pneumologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Abstract
This review analyses the available literature on the economic aspects of obstructive sleep apnoea,
including the indirect medical costs, the indirect nonmedical costs, the direct costs of diagnosing
and treating the disease, and the utilities as perceived by patients. The philosophical context of
health economics is also considered. The literature available on the economic aspects of
obstructive sleep apnoea is scarce, and frequently incomplete, so that only tentative conclusions
can be reached. Obstructive sleep apnoea seems to lead to measurable (about two-fold) increases
in indirect medical costs. Moreover, this excess cost seems to be reduced in the first years following
the institution of treatment with nasal continuous positive airway pressure (nCPAP). There are also
indirect nonmedical costs linked to the disease, for example traffic, domestic and workplace
accidents. The exact extent of these costs is, however, impossible to ascertion from the available
literature. Cost/utility analysis has shown full-night polysomnography to be the diagnostic approach
with the higher cost/utility ratio, because diagnostic errors (greater with other approaches) carry a
disproportionate weight. The cost of treating the disease has not been thoroughly assessed but
appears as quite reasonable, and certainly not excessive. Finally, one study has shown in patients
with severe sleep apnoea that treatment with nCPAP has a favourable effect when measured as
quality adjusted life years. It is concluded that obstructive sleep apnoea leads to an excess in
health-related expenditure, that treatment with nasal continuous positive airway pressure reduces
this excess cost and thus makes sense in economic terms, and that patients believe nasal
continuous positive airway pressure treatment to be worth considering for economic reasons. It is
further concluded that medical decisions should be guided by medical (not economic)
considerations, even if it is acknowledged that, for the time being, economic analysis is necessary
to to convince health managers that obstructive sleep apnoea is also worth considering from the
economic point of view.
Sleep Med Rev. 2004 Aug;8(4):269-79.
Health care costs and the sleep apnea syndrome.
Wittmann V, Rodenstein DO.
Source
Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels,
Belgium.
Abstract
This paper reviews some concepts on health economics from the authors personal perspective. It
then examines the few papers published on health economics analysis applied to the field of sleep
apnea syndrome, as well as the literature on the indirect (cost) consequences of sleep apnea
syndrome. It appears that undiagnosed sleep apnea leads to a roughly two-fold increase in medical
expenses in the years preceding the diagnosis and that treating the disease (once it is diagnosed)
results in a decrease in these excess costs. It seems clear that sleep apnea increases the actual
number of road traffic accidents, which will carry a definite, but unmeasured up to now, economic
cost consequence. From the health economic point of view, the best diagnostic strategy is the one
with the greater utility (i.e. polysomnography), although it could appear at first sight to be the more
expensive one. From the patient's perspective, sleep apnea results in a given decrease in the
possibilities to enjoy life, and its treatment is worth considering, especially if one takes into account
that the actual treatment costs are not great. The global image of the health costs related to sleep
apnea is still blurred, and further work is required to get the complete and clear picture of the
economic consequences of this disease and of its treatment.
Copyright 2004 Elsevier Ltd.
Comment in

Factors limiting access to services for sleep apnea patients. [Sleep Med Rev. 2004]
Sleep Med Rev. 2004 Aug;8(4):269-79.
Health care costs and the sleep apnea syndrome.
Wittmann V, Rodenstein DO.
Source
Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels,
Belgium.
Abstract
This paper reviews some concepts on health economics from the authors personal perspective. It
then examines the few papers published on health economics analysis applied to the field of sleep
apnea syndrome, as well as the literature on the indirect (cost) consequences of sleep apnea
syndrome. It appears that undiagnosed sleep apnea leads to a roughly two-fold increase in medical
expenses in the years preceding the diagnosis and that treating the disease (once it is diagnosed)
results in a decrease in these excess costs. It seems clear that sleep apnea increases the actual
number of road traffic accidents, which will carry a definite, but unmeasured up to now, economic
cost consequence. From the health economic point of view, the best diagnostic strategy is the one
with the greater utility (i.e. polysomnography), although it could appear at first sight to be the more
expensive one. From the patient's perspective, sleep apnea results in a given decrease in the
possibilities to enjoy life, and its treatment is worth considering, especially if one takes into account
that the actual treatment costs are not great. The global image of the health costs related to sleep
apnea is still blurred, and further work is required to get the complete and clear picture of the
economic consequences of this disease and of its treatment.
Copyright 2004 Elsevier Ltd.
Ontario
Población
Estudios Psg
Costo x Psg
Costos total
en dx.
Famisanar
Diagnostico
Cx bariatrica
13,505,900
96000
$ 498 usd
$47.000.000
17,350 usd. Por cx
Bogotá
8.000.000
56000 Cifra esperada
$191 usd ($350.000)
10696,000 usd
19.573.680.000
19000 Psg de diagnostico
$ 665.000.0000
38.000 Psg Dx + Titulación
$1.330´000.000
10% de población con
obesidad
2% obesidad mórbida.