Table 1.
Model parameters
| Variable | Base Case | Range | Reference |
|---|---|---|---|
| Cohort Characteristics | |||
| Sex | Male | ||
| Age | 50 | 30–70 | |
| Risks Associated with Events and Modeled States | |||
| Motor vehicle collision causing injury or death | |||
| Annual risk, males | 0.025 | 0.023–0.027 | 21 |
| Annual risk, females | 0.011 | 0.010–0.013 | 21 |
| Probability of death from a MVC with injury or death | 0.0079 | 0.006–0.01 | 39 |
| Hypertension | |||
| Prevalence of hypertension, Males (varies by age, 40-70 y) | 0.239–0.633 | 19 | |
| Prevalence of hypertension, Females (varies by age, 40-70 y) | 0.199–0.788 | 19 | |
| Rate (annual per person, until age 85) for incident hypertension, Males | 0.0195 × ln(Age) – 0.0551 | ± 10% rate | 19 |
| Rate (annual per person, until age 85) for incident hypertension, Females | (2.5 × 10-7) × Age2.948 | ± 10% rate | 19 |
| Hazard ratio for all-cause mortality, life with Hypertension | 1.49 | 1.0–2.2 | 20 |
| Myocardial infarction | |||
| Rate (annual per person, until age 85) for incident MI, Males | (2.0 × 10-12) × Age5.236 | 16 | |
| Rate (annual per person, until age 85) for incident MI, Females | (9.0 × 10-17) × Age7.423 | 16 | |
| Hazard ratio for incident MI, with Hypertension | 2.53 | 2.0–3.5 | 20 |
| Probability of 28-day mortality, males, varies by age | 0.15–0.7 | 50,51 | |
| Probability of 28-day mortality, females, varies by age | 0.20–0.7 | 50,51 | |
| Hazard ratio for all-cause mortality, life after MI | 1.57 | 1.35–1.74 | 52 |
| Stroke | |||
| Rate (annual per person, until age 85) for incident stroke | (3.1 × 10-13) × Age5.569 | 17,18 | |
| Hazard ratio for incident stroke, with Hypertension | 2.78 | 2.0–4.6 | 20 |
| Probability of 28-day mortality, varies by age | 0.09–0.52 | 18 | |
| Hazard ratio for all-cause mortality, life after stroke | 2.30 | 1.1–2.8 | 53 |
| Diagnostic Test Characteristics | |||
| Full night PSG | |||
| Sensitivity | 0.97 | 0.85–1.00 | 6,54 |
| Specificity | 1.00 | 0.85–1.00 | 6,54 |
| Split night PSG | |||
| Sensitivity | 0.89 | 0.76–0.95 | 54 |
| Specificity | 0.94 | 0.72–1.00 | 54 |
| Unattended home monitoring (Type III) | |||
| Sensitivity | 0.91 | 0.83–0.94 | 54,55 |
| Specificity | 0.83 | 0.67–0.94 | 54,55 |
| Technical failure | 0.09 | 0.07–0.12 | 54 |
| Refuse FN-PSG given technical failure | 0.22 | 0–0.44 | 12 |
| CPAP Titration | |||
| Successful titration during split-night PSG | 0.82 | 0.80–0.90 | 6 |
| Successful autotitration during unattended home monitoring | 0.87 | 0.80–0.90 | 56 |
| CPAP Treatment Compliance | |||
| Initial treatment refusal | 0.102 | 0–0.204 | 23 |
| Annual probability of stopping treatment | 0.044 | 0.022–0.086 | 26 |
| Hazard Ratios Associated with OSA | |||
| HR for motor vehicle collision causing injury or death | 3.0 | 2.5–3.5 | 23,24 |
| HR for developing hypertension | 1.8 | 1.3–1.9 | 25 |
| HR for incident MI | 2.8 | 1.9–4.3 | 8 |
| HR for incident stroke | 1.7 | 1.0–3.5 | 22 |
| Costs | |||
| Diagnosis | |||
| Office visits | 89.90 | CPT 99214 | |
| FN-PSG | 810.86 | −10%, +20% | CPT 95810 |
| SN-PSG | 891.14 | −10%, +20% | CPT 95811 |
| UPHM | 209.17 | −10%, +20% | CPT 95806 |
| Titration | |||
| PSG titration | 891.14 | −10%, +20% | CPT 95811 |
| Auto titration | 209.17 | −10%, +20% | CPT 95806 |
| Treatment (monthly) | |||
| CPAP, rental | 111.71 | HCPCS E0601, for 13 months then owned | |
| CPAP replacement time (years) | 5 | 2–10 | |
| CPAP supplies | 114 | 38–380 | 1/3 of maximum allowable from HCPCS A7030-A7039, A7045, A7046 |
| Office visits (each, assumed 2 per year) | 89.90 | CPT 99214 | |
| Acute Events (one-time) | |||
| Non-fatal MVC with injuries | 7,500 | 50–200% | 39 |
| Fatal MVC | 28,100 | 50–200% | 39 |
| Acute MI | 15,110 | 37 | |
| Acute Stroke | 20,419 | 38 | |
| Death from cause other than MI, stroke, MVC; varies (decreases) by age | 24,122–40,801 | 34 | |
| Health state specific costs (monthly) | |||
| Baseline, increases by age | 403–1,543 | 33 | |
| Health state specific care costs | |||
| Hypertension, additive | 56.76 | 25–115 | 35 |
| Post-MI, multiplicative | 1.76 | 1.6–2.2 | Assumed to be the same as stroke |
| Post-Stroke, multiplicative | 1.76 | 1.6–2.2 | 36 |
| Quality of Life Weights | |||
| Baseline, varies (decreases) by age (40-80 years) | 0.871–0.736 | 29 | |
| Health state specific quality of life weights, multiplicative | |||
| Well | 1 | ||
| Hypertension | 0.96 | 0.95–1.0 | 29 |
| Post-MI | 0.86 | 0.80–1.0 | 29 |
| Post-Stroke | 0.81 | 0.78–1.0 | 29 |
| Untreated OSA | 0.84 | 0.80–0.93 | 31,32 |
| Treated OSA | 0.93 | 0.84–0.98 | 31,32 |
| CPAP without OSA | 0.98 | 0.96–1.0 | Estimated |
| Non-fatal MVC (lifetime discounted decrement, subtractive) | 0.036 | 0.031–0.418 | 30 |