PURPOSE: Long wait times for sleep evaluation in veterans has been suggested (AJRCCM 2004:169:668). In order to shorten wait times, alternative management (AM) strategies –screening pulseoximetry and automatic-positive airway pressure (APAP) therapy –have been performed (Chest 2006; 129:638). However, whether AM strategies improve access to care and save costs within the veterans healthcare system is unknown. Our objective was to determine whether an AM strategy for veterans with possible OSA can decrease wait times and costs compared to conventional management (CM).
METHODS: Veterans with high probability for OSA –presence of witnessed apneas, Epworth sleepiness score > 10, and desaturation index by overnight pulseoximetry > 5 per hour –underwent in-hospital APAP therapy overnight. Veterans who did not meet all 3 of the above-mentioned criteria, or who failed APAP therapy, underwent overnight polysomnography.
RESULTS: In 103 consecutive veterans (6 women; age 59 + 11 [SD] years), 36 patients were eligible for, and completed, the AM strategy. Thirty-three veterans underwent the CM strategy. Twenty-four patients were lost to follow up. Of the rest, 4 expired, 1 refused therapy, and 5 were not eligible. The wait times between referral and initiation of PAP therapy was not different between the AM and CM groups: 237 + 196 and 273 + 177 [SD] days, respectively (P=0.56). In contrast, the cost incurred for the AM strategy was much lower than that for CM strategy: $133 versus $837 per patient, respectively. For the entire group, with 36 (55%) of 66 patients being eligible for the AM strategy, a cost savings of $384 per patient was achieved. At the current annual referral rate (720) at our institution, $276,000 per annum may be saved.
CONCLUSION: Alternative management strategies for veterans with OSA involving in-hospital APAP titration did not improve access to care but realized significant cost savings.
CLINICAL IMPLICATIONS: Wait times are long for veterans with possible OSA. Access to care for veterans needs to be improved by other novel methods.
DISCLOSURE: Adil Imran, None.