Cost-benefit analysis of polysomnography versus Clinical Assessment Score-15 (CAS-15) for treatment of pediatric sleep-disordered breathing

Abstract

Objective: To determine the cost of medical care using the Clinical Assessment Score-15 (CAS-15) scale versus polysomnography (PSG) for children with sleep-disordered breathing in terms of benefit.

Study design: Cost-benefit analysis.

Setting: Hospital-based pediatric otolaryngology practice.

Subjects and methods: Ninety-three patients from our original CAS-15 study were included. Four clinical measures were used and payment data were obtained. Cost-benefit analysis was performed for 2 clinical pathways. In pathway 1, all children had PSG; those with positive studies were referred for adenotonsillectomy. In pathway 2, children with CAS-15 ≥ 32 were referred for adenotonsillectomy regardless of PSG. Paired t test compared intrasubject mean total cost (pathway 1 vs pathway 2). Further analyses computed a change score for the clinical measures (follow-up minus baseline); these were divided by estimated treatment cost, producing 4 cost-benefit ratios for each pathway. Paired t tests compared the mean of these ratios between the 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 $US1172 (SE = $214) for pathway 2 versus pathway 1 (P < .001). CAS-15 is also cost-beneficial versus PSG in 3 of 4 clinical measures (Child Behavior Checklist total problem T score, P = .008, mean OSA-18 survey score, P < .001, apnea hypopnea index, P < .001).

Conclusions: We present evidence that a CAS-15-based treatment decision criterion is superior to PSG in terms of monetary cost and in benefit per unit cost for 3 of 4 clinical measures evaluated.

Keywords: CAS-15; OSA; PSG; clinical assessment score; cost; cost-benefit analysis; obstructive sleep apnea; pediatric sleep disordered breathing; polysomnography.