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| #88 |
| Cost Justification |
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Rarely do I depart from my practice of reviewing only primary research reports, but this short editorial seemed too important to neglect. A position paper signifies that an agreement exists as to the validity of the content on the part of those responsible for an organization's public pronouncements. It is an important statement, its wording carefully chosen, accepted by a group of leading experts in the field, and is rarely retracted, unlike the ever-changing "positions" of politicians. Here I will summarize what I (alone) consider its most important points. (1)Costs of health care for sleep-disordered breathing (SDB) have increased substantially over the past 30 years, since the Obstructive Sleep Apnea Syndrome (OSAS) was first clearly defined. (2)Untreated SDB is associated with increased risk of morbidity (complications) and mortality (premature death). The probability of death within a defined period of time increases with increasing severity of SDB. Untreated SDB probably contributes to hypertension, strokes, heart attacks, and automobile accidents. (3)Before being treated for SDB, people with SDB, in contrast to matched control groups without SDB, get hospitalized more often (about three times more often), stay in hospitals longer, and cost more (about twice as much) for doctors and overall health care. (4)From a single study, patients receiving treatment for SDB, compared to untreated controls, costed 1/3 less for doctors and spent less time in the hospital. Overnight laboratory sleep studies, compared to physician evaluations without these studies, also lower the cost of subsequent diagnostic and treatment procedures. Their cost compares favorably with other outpatient tests; for example, a common test for narrowing of the carotid artery to the head (a cause of strokes) costs four times as much as a sleep study.
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Professional journals in general, and position statements in particular, tend to hedge their conclusions with words like "appears to be" and "likely plays a role," which I have left out. However, this position paper refers to the actual studies which support its statements, and furthermore makes it clear where data remains too limited to draw any real conclusions (for example, point #4 above). However, studies mentioned represent good science, at least the best available on the issue. Many more studies with less excellent methods may exist to support the conclusion of the "exemplary" research. Furthermore, we can trust the editors not to fail to mention contrary results from studies with equally excellent methods. It seems clear to me that the position paper targets those parties most responsible for paying the cost of sleep studies, treatment with CPAP, etc--that is to say, the health insurance companies, the health maintenace organizations (HMOs), and the government. Nevertheless, we the patients may use these points in our individual disagreements with third parties over what they might try to resist covering. We may also refer to them in individual and collective appeals to our elected officials. Lastly, we may have need to confront someone resistant to evaluation and treatment for OSA with the facts set forth by this pre-eminent group of sleep medicine experts--to shake the denial we often encounter in our spouses, relatives, friends--and sometimes ourselves.
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"Sleep...Oh! how I loathe those little slices of death" Longfellow
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