OBJECTIVE To describe the cost-benefit of four different approaches to screening for sleep apnea in a cohort of participants with moderate to severe TBI receiving inpatient rehabilitation from the payor's perspective. DESIGN A cost-benefit analysis of phased approaches to sleep apnea diagnosis. SETTING Six TBI Model System Inpatient Rehabilitation Centers PARTICIPANTS: Trial data from 214 participants were used in analyses (mean age 44 [SD 18], 82% male, 75% white, with primarily motor-vehicle related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8 (SD 5). INTERVENTION Not applicable. MAIN OUTCOME Cost-benefit RESULTS: At AHI ≥15 (34%), phased modeling approaches using screening measures (STOPBANG [-$5,291], MAPI [-$5,262]) resulted in greater cost savings and benefit relative to the portable diagnostic approach (-$5,210) and initial use of laboratory-quality polysomnography (-$5,011). Analyses at AHI ≥5 (70%) revealed the initial use of portable testing (-$6,323) relative to the screening models (MAPI [-$6,250], STOPBANG [-$6,237) and initial assessment with polysomnography (-$5,977) resulted in greater savings and cost effectiveness. CONCLUSION The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-beneficial approach varying by incidence of OSA.

中文翻译：

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中重度 TBI 住院康复期间筛查和诊断 OSA 的支付方成本效益分析

目的 从付款人的角度描述在接受住院康复治疗的中度至重度 TBI 参与者队列中，四种不同的睡眠呼吸暂停筛查方法的成本效益。设计 睡眠呼吸暂停诊断分阶段方法的成本效益分析。设置六个 TBI 模型系统住院康复中心 参与者：来自 214 名参与者的试验数据用于分析（平均年龄 44 [SD 18]，82% 男性，75% 白人，主要与机动车相关的伤害 [44%] 和跌倒 [ 33%]，样本平均急诊科格拉斯哥昏迷量表为 8 (SD 5)。干预不适用。主要结果成本效益结果：在 AHI ≥15 (34%) 时，使用筛选措施的分阶段建模方法 (STOPBANG [-$5,291 ], MAPI [-$5, 262]) 与便携式诊断方法 (-5,210 美元) 和实验室质量多导睡眠图的初始使用 (-5,011 美元) 相比，节省了更多的成本和收益。AHI ≥ 5 (70%) 的分析显示，相对于筛查模型（MAPI [-$6,250]、STOPBANG [-$6,237）和多导睡眠图的初步评估（-$5,977），最初使用便携式测试（-$6,323）可以节省更多成本和成本效益。结论 TBI 后睡眠呼吸暂停的高发生率突出了准确诊断和治疗这种合并症的重要性。然而，在住院康复住院期间获得早期诊断存在经济和实际障碍。所有分阶段方法和 OSA 严重程度都证明了诊断成本的节省，其中最具成本效益的方法因 OSA 的发生率而异。