ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2025
Cost-utility analysis of a tiered diagnostic approach combining a screening model and polysomnography in pediatric obstructive sleep apnea.
Article in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
STUDY
objectivesObstructive sleep apnea (OSA) is a common disorder in the pediatric population, primarily diagnosed through polysomnography (PSG). However, PSG can be expensive and is often limited in availability. This study aimed to develop a cost-effective diagnostic strategy by integrating a screening model with PSG.
methodsA retrospective analysis was conducted on children suspected of OSA. Screening models were initially constructed with machine learning techniques. Cost-utility analyses compared 3 diagnostic strategies: (1) PSG alone, (2) the screening model alone, and (3) the screening model-PSG combined, in the discovery and validation cohorts. Cost-utility was measured using the incremental net monetary benefit.
resultsA total of 690 children were included. The logistic regression model using age, tonsil scale, OSA questionnaire-18 questions 1 and 2, and oxygen desaturation index 3% predicted OSA with an area under the curve of 0.91. In the cost-utility analysis, the "PSG alone" strategy, as the baseline, was the most beneficial (utility 0.9557) at Chinese yuan (CNY) 4,523.98. The "screening model alone" had 91.6% sensitivity and 59.3% specificity, offering lesser value (utility 0.9337) at CNY 6,071.51 (incremental net monetary benefit CNY -3,966.43) when compared to "PSG alone." The "screening model-PSG combined" strategy increased sensitivity to 100%, specificity to 99.2%, and utility to 0.9554 at CNY 4,463.36, establishing it as the most cost-effective option with an incremental net monetary benefit of CNY 34.22. One-way sensitivity analyses and adaptation to United States cost parameters confirmed the robustness of these results.
conclusionsUsing the screening model as a triage tool for PSG enhances the cost-effectiveness of pediatric OSA management. CITATION: Xu S, Li Y, Han D. Cost-utility analysis of a tiered diagnostic approach combining a screening model and polysomnography in pediatric obstructive sleep apnea.
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