“Assessing Diagnostic Accuracy & Cost Effectiveness Of Level I & Level III for Diagnosis Of Obstructive Sleep Apnea In India: Health Technology Assessment”

Abstract

E Objective: Obstructive sleep apnea (OSA) is the most common and the severe form of sleep breathing disorder (OSA). In India, prevalence ranges from 8% to 19% and associated with comorbidities (diabetes, higher BMI), which are also increasingly prevalent in India. Increasing prevalence of OSA and its awareness results in higher demand of diagnostic screening through sleep studies or polysomnography (PSG), which are resource and cost intensive. It is often undiagnosed in India, specifically in rural settings where 70% of total population lives. This study aims to assess the cost-effectiveness of Level I(PSG) and Level III (portable-device) diagnostic tests to diagnose OSA for Indian population.

Methods: A decision-analytical model was built in the Excel, comparing Level I, Level III and no screening using 1-year time horizon with a healthcare perspective in India. For the diagnostic accuracy, meta-analysis was performed via a bivariate mixed effect. Binary regression model used to estimate summary diagnostic accuracy parameters using Revman 5.3 and STATA 14. Studies were included from 2006 to 2019 and associated protocol was published in PROSEPRO database (CRD42018110619).

Results: This study showed incremental cost-effectiveness analysis of OSA screening through Level III could save INR 559,888.63 (USD 1,08,03,050.48) per QALY gained.

Conclusion: Diagnosis of OSA with portable Level III is a feasible and acceptable alternative in rural populations. In addition, screening is very cost-effective with the level III study. Though there is limited data on OSA diagnosis in rural India, there is a need to implement systems and policies to address this issue.