Figure 2.

Total cost of screening strategy as a function of the cost of missing a case of sleep apnea syndrome (defined by AHI≥5 events/h with sleepiness defined by Epworth score >10). The cost of the polysomnography program (heavy black line) is is fixed at $920=$768 for testing each driver, plus $152/driver screened for the cost of treatment. Cost of oximetry and modified multivariable prediction were assumed to be $160 and $5, respectively. The figure shows costs (on y-axis) for full polysomnography (heavy black line) and doing nothing (thin black line) compared against one-stage screening (thin gray line) and two-stage screening (heavy gray line). The horizontal axis shows the variable cost of a missed case (bottom labels). Not screening is least expensive when a missed case costs less than $6,100. When missing a case costs between $6,100 and $22,700, one-stage screening is the least expensive strategy. When a missed case costs more than $6,500, two-stage screening is also less expensive than not screening. Polysomnography is less expensive than two-stage screening when a missed case costs more than $21,000, and less expensive than one-stage screening when the cost of a missed case is more than $22,700.