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A cost-effectiveness analysis of OSA screening with home sleep testing for pregnant women with chronic hypertension
Abstract Number: SAT-38
Abstract Type: Original Research
Introduction: 17 to 29% of pregnant women with cHTN will go on to develop preeclampsia (PEC); both diseases increase a woman’s risk of preterm delivery and other morbidities. CHTN and PEC are both associated with obstructive sleep apnea (OSA) in pregnancy. OSA may complicate the pregnancies of more than 40% of pregnant women with cHTN. CHTN in premenopausal women may indicate underlying sympathetic activation due to OSA. Established OSA screening tools have not performed well in pregnant populations and are associated with a high false referral rate for overnight, in-lab polysomnography (PSG). Portable home sleep testing (HST) is emerging as a reliable and cost-effective method of screening for OSA. Our objective here was to utilize decision modeling to estimate the cost-effectiveness of routine OSA screening with HST of pregnant women with cHTN.
Methods: We created a decision tree to estimate and compare the cost of HST early in pregnancy followed by PSG in women with cHTN compared to the “do-nothing” scenario (FIGURE). We assumed that the prevalence of PEC and preterm birth could be affected by diagnosing OSA and treating with continuous positive airway pressure (CPAP). We conducted a literature search using the PubMed database to find the best available evidence to support the model, and constructed the model and conducted the analysis using TreeAgePro 2016. Our primary outcome was cost/preterm birth saved. We performed a one-way, sensitivity analysis in which model probabilities and costs were tested across a range of values, as well as a sensitivity cost-effectiveness analysis to test the effect of CPAP compliance on cost and preterm birth rate.
Results: Screening for OSA with HST and treating if PSG was positive cost an average of $12.41 less than the “do-nothing” scenario ($7,705 vs. $7,718), and decreased the rate of preterm birth among women with cHTN by 4% (31% vs. 35%). The sensitivity analysis showed that cost-savings began when compliance with CPAP therapy was 60% or greater, with maximal savings and reduction of preterm birth at 100% CPAP compliance ($276 saved, 6% decrease in preterm birth).
Conclusions: Using decision analysis tools, we estimated that OSA screening with HST and CPAP treatment for all pregnant women with cHTN is cost saving and reduces the incidence of preterm birth when compliance with CPAP therapy exceeds 60% based on the assumption that CPAP therapy reduces the risk of PEC in women with cHTN and OSA.