Table 5.
Sensitivity analysis: Incremental cost effectiveness ratios compared to the next best diagnostic strategy under various scenarios
| Scenario | No Diagnosis & No Treatment* | Split-Night PSG | Full-Night PSG | Unattended Portable Home Monitoring | Empiric Treatment |
|---|---|---|---|---|---|
| Base case | Dominated | 17,131 | Dominated | Dominated | |
| Test Characteristics | |||||
| Best case, FN | Dominated | 17,095 | Dominated | Dominated | |
| Worst case, FN | 19,876 | Dominated | 516,167 | 2,333,995 | |
| Best case, both FN & SN | 16,777 | Dominated | Dominated | Dominated | |
| Worst case, both FN & SN | Dominated | 20,448 | 48,206 | 2,333,995 | |
| Best case UPHM | Dominated | 17,131 | Dominated | Dominated | |
| Worst case UPHM | Dominated | 17,131 | Dominated | Dominated | |
| No patient refuses FN-PSG after technical failure with UPHM | Dominated | 17,131 | 782,167 | Dominated | |
| No technical failure from UPHM | Dominated | 17,131 | Dominated | Dominated | |
| OSA related risks | |||||
| Decreased impact of OSA on MVC risks | Dominated | 18,036 | Dominated | Dominated | |
| Increased impact of OSA on MVC risks | Dominated | 16,281 | Dominated | Dominated | |
| Decreased impact of OSA on hypertension risks | Dominated | 17,974 | Dominated | Dominated | |
| Increased impact of OSA on hypertension risks | Dominated | 16,551 | Dominated | Dominated | |
| Decreased impact of OSA on MI &stroke risk | Dominated | 23,554 | Dominated | Dominated | |
| Increased impact of OSA on MI & stroke risk | Dominated | 14,821 | Dominated | Dominated | |
| Efficacy of therapy | |||||
| Only MVC benefit | Dominated | 25,986 | Dominated | Dominated | |
| Only CV benefit | Dominated | 20,362 | Dominated | Dominated | |
| 75% of MVC and CV benefit | Dominated | 19,448 | Dominated | Dominated | |
| 50% of MVC and CV benefit | Dominated | 22,582 | Dominated | Dominated | |
| 25% of MVC and CV benefit | Dominated | 26,827 | Dominated | Dominated | |
| 0% of MVC and CV benefit (only benefit is the utility gain from reduced day-time sleepiness) | Dominated | 32,675 | Dominated | Dominated | |
| Compliance with Therapy | |||||
| Perfect compliance | Dominated | 16,696 | Dominated | Dominated | |
| Low compliance: Double the number of patients who never try therapy, & double the quit rate | Dominated | 17,726 | Dominated | Dominated | |
| False Positives self-identify by quitting CPAP therapy at 12 times the rate of True Positives | 17,074 | 51,557 | Dominated | 817,009 | |
| Cost | |||||
| Low FN-PSG cost | Dominated | 17,031 | Dominated | Dominated | |
| High FN-PSG cost | Dominated | 17,330 | Dominated | Dominated | |
| Low SN-PSG cost | Dominated | 17,131 | Dominated | Dominated | |
| Low UPHM cost | Dominated | 17,131 | Dominated | Dominated | |
| Low CPAP treatment cost | Dominated | 9,856 | Dominated | Dominated | |
| High CPAP treatment cost | Dominated | 42,593 | Dominated | Dominated | |
| Low cost of MVC | Dominated | 18,492 | Dominated | Dominated | |
| High cost of MVC | Dominated | 14,409 | Dominated | Dominated | |
| Low cost of CV chronic care | Dominated | 18,243 | Dominated | Dominated | |
| High cost of CV chronic care | Dominated | 13,947 | Dominated | Dominated | |
| Utilities | |||||
| Annualized equivalent of 2 days lost for attending sleep clinic for FN-PSG or SN-PSG | Dominated | 17,304 | Dominated | Dominated | |
| No utility gain from reduction in day-time sleepiness (only benefit is the utility gain from reduced MVC and CV risks) | Dominated | 37,974 | Dominated | Dominated | |
| Large utility gain associated with treated OSA; same as no OSA with CPAP (2% reduction from age-specific HR-QoL) | Dominated | 13,325 | Dominated | Dominated |
*
“No Diagnosis & No Treatment” was the least costly strategy in all scenarios tested. It is the comparator for the next strategy on the efficient frontier.
Dominated & Strategies that are not on the efficient frontier are described as dominated. Dominated strategies cost more and provide fewer QALYs than another strategy or a combination of strategies available to the decision-maker.