Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea...
Transcript of Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea...
![Page 1: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/1.jpg)
Economics of sleep apnea
Philip Jacobs Institute of Health Economics and
University of Alberta Alberta Sleep Forum Oct.24, 2013
1
![Page 2: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/2.jpg)
Disclosure
• Other peoples’ data
• Other peoples’ ideas
• No funding on related projects
• No conflict of interest
2
![Page 3: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/3.jpg)
3
![Page 4: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/4.jpg)
In the USA…
4
![Page 5: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/5.jpg)
Prevalence of sleep apnea - Canada
• 858,900 diagnosed adults >18 (3% of that population)
• 5% in adults >45
• Associated with other health problems
– Public Health Agency of Canada, 2010
5
![Page 6: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/6.jpg)
Prevalence of sleep apnea - Alberta
• Population 3.165 million (age 15+)
• 3% = 90,000 (diagnosed)
6
Alberta
![Page 7: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/7.jpg)
But…
• “Of those affected by sleep-disordered breathing, fewer than 15 percent have been diagnosed and treated. “
• The Real 800-Pound Gorilla of Presenteeism
• by Peter Farrell, HBR, 2013
7
![Page 8: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/8.jpg)
Total with sleep apnea
8
X 6
Treated
![Page 9: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/9.jpg)
Qualification
• Six country study
• Q: Able to sleep through the night?
• Mexico 64%
• Canada 55% (ranks 2)
• Source: National Sleep Foundation, 2013 International Bedroom Poll
9
![Page 10: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/10.jpg)
Impact on quality of life
• Quality Adjusted Life Years
10
1.00
0
![Page 11: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/11.jpg)
Impact of O.S.A. on QALYs
11
1.00
0
0.93 Treated OSA 0.84 Untreated OSA
Treatment 7% vs 16% capacity Loss without treatment
Pietzsch, SLEEP 34:695
![Page 12: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/12.jpg)
Impact of OSA on resources
• Medical costs
• Losses due to accidents (work / road)
• Reductions in worker productivity
12
![Page 13: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/13.jpg)
Management of sleep apnea
• Diagnosis
• Treatment
• Prevention
13
![Page 14: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/14.jpg)
Resources and costs - diagnosis
• Diagnosis
– Sleep lab
– Respirologist
– Respiratory therapist
Ontario : overnight sleep study (public pay)
$375
14
![Page 15: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/15.jpg)
Diagnosis coverage
• AHS
15
![Page 16: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/16.jpg)
Wait times for (public) polysomnography
11.6 months
• Rotenberg BW. Wait times for sleep apnea care in Ontario: A multidisciplinary assessment. Can Respir J. 2010 Jul-Aug; 17(4): 170–174.
16
![Page 17: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/17.jpg)
Private labs
• US: Polysomnography: $2,625 average (private) (US Sleep Study)
• Alberta $1,200 - $1,500
17
![Page 18: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/18.jpg)
Resources and costs - treatment
• Pulmonary physician
• CPAP machine $1,000 - $2,500
18
![Page 19: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/19.jpg)
CPAP Coverage
• Private insurance
• AISH (severely handicapped)
• Social Services
• All the rest pay themselves
19
![Page 20: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/20.jpg)
Medical cost offsets
• OSA versus Non OSA (Control)
• Year before diagnosis
– Fifth year before
– Fifth year after
20
![Page 21: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/21.jpg)
Medical cost offsets
($40)
($20)
$0
$20
$40
$60
$80
$100
$120
$140
$160
OSA CONTROL
BEFORE CPAP
AFTER CPAP
Source:Albarrak, SLEEP 2005
5 YEARS
21
MD Fees
![Page 22: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/22.jpg)
Medical costs
• Looks at physician fees only
• OSA and other medical services
22
![Page 23: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/23.jpg)
“Indirect” costs
• Car and Workplace accidents (Harvard Sleep)
23
$12 billion
$7 billion
![Page 24: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/24.jpg)
“Indirect” costs
• Absenteeism
24
$16.6 billion
![Page 25: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/25.jpg)
“Indirect” costs
• Presenteeism • The Real 800-Pound Gorilla of Presenteeism
• by Peter Farrell
• HBR Blog May 22, 2013
25
![Page 26: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/26.jpg)
Components of a decision
• Budget
• Outcomes
26
![Page 27: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/27.jpg)
Treatment impact
• Costs
• Outcomes
• Costs and outcomes
27
Cost effectiveness
![Page 28: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/28.jpg)
Areas impacted by treatment
• Medical costs of screening, diagnosis, and treatment
• Vs
• Benefits – Quality of life
– Medical costs for non-treatment
– Road and workplace accidents
– Absenteeism
– Presenteeism
28
![Page 29: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/29.jpg)
APAP versus CPAP
• Outcomes
– Treatment pressures (lower for APAP)
– Clinical measures
• AHI scores (hypopnea index)
• Daytime sleepiness
• Arousals
• % REM sleep (rapid eye movement)
• Oxygen saturation
• Results: APAP about same as CPAP
29
![Page 30: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/30.jpg)
APAP costs
• APAP versus CPAP – Treatment (longer term)
• Costs – Diagnosis
• Lab $750 • APAP $200
– Titration • CPAP $750 • APAP $200
– Treatment • CPAP $1,200 • APAP $2,250
30
![Page 31: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/31.jpg)
Cost summary CPAP vs APAP
200 750 200
750
2250
1200
APAP CPAP
Diagnosis Titration Treatment
31
![Page 32: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/32.jpg)
Summary APAP vs CPAP
• Costs about the same
• Outcomes about the same
32
![Page 33: Economics of sleep apnea - American Lung Association · 2017-06-26 · Economics of sleep apnea Philip Jacobs Institute of Health Economics and University of Alberta Alberta Sleep](https://reader034.fdocuments.net/reader034/viewer/2022050107/5f452d4e9b68de78a374ca7c/html5/thumbnails/33.jpg)
Summary
• Clinicians look only at the outcomes and effectiveness
• Directors look only at budgetary impacts
• Health technology assessment compares both
• together
• But nobody looks at cost effectiveness
33