| LinkExchange Member | Free Home Pages at GeoCities |
| LinkExchange Member | Free Home Pages at GeoCities |
Send comments or suggestions to kerrinwh @ix.netcom.com
For some audience responses to date, CLICK HERE
To return to main page, CLICK HERE
Despite initial opposition from public and private insurers, the advocacy of self-help groups and patient associations have contributed to improvement in the German system for diagnosing and treating sleep-related breathing disorders over the past 10 years. This has led to establishment of about 90 accredited sleep centers and 700 sleep specialists in Germany now, associated with annual costs of about 100 million DEM. It is necessary to demonstrate that this substantial increase in funding for sleep medicine has resulted in reduction of other costs of untreated sleep disorders.
The authors consider the prevalence of obstructive sleep apnea in the overall population to be somewhere between 1 and 10%, depending on characteristics of the population investigated--i.e., age, sex, presence or absence of obesity and hypertension.
The risk of excessive daytime sleepiness in the workplace is 37 times higher in patients with OSA than in workers without OSA, and patients with untreated OSA have 10 times as much difficulty learning new tasks at work as the average worker. The authors found that the performance readiness and vigilance of patients with an AHI equal to or greater than 10 was similar to that of patients who have applied for a disability pension. Within four weeks of starting treatment, OS patients had substantially improved, even more so after 6 months. After 6 months, the "effect size" of the CPAP treatment was 0.98, meaning that the difference between pre-treatment and post-treatment functioning was approximately equal to the standard deviation of this difference (see Glossary). For comparison, the effect size of sympathomimetic bronchodilator treatment for patients with chronic obstructive airway disease (see Glossary) was 0.92.
In a different study, another author found that the incidence of auto accidents in patients with OSA was reduced fivefold by effective treatment.
In one cost-utility analysis, CPAP was estimated to add 5.4 quality-adapted years to a patient's life.
In Germany in 1996, 15,000 CPAP devices were prescribed, equivalent to 0.075% of the 20 million insured men and women ages 35-65, costing 3,500 DEM the first year and 1,900 DEM the second year per CPAP. Taking these figures into consideration, the authors calculated that by diagnosing and treating their sleep apneics, the German economy had realized a net profit of 409 million DEM the first year and 433 million DEM the second year, amounting to an average annual monetary benefit of 2.35 billion DEM over the next 10 years. They conclude with remarkable understatement that "the benefits surpass the costs incurred."
It may not sound that way from my Summary, but this article made tough reading because of the repeated assumptions of familiarity of the reader with measures that would be quite unfamiliar to an American, even one well acquainted with medical research. However, I think I have correctly stated the essence of most of their points, while omitting reference to those points that I didn't fully understand.
The main point is very simple: paying for diagnosis and treatment of sleep apnea will, in the short as well as the long run, yield vast economic benefits for our society. This shouldn't amaze anyone, given that sleep apnea is a chronic, disabling condition with medical complications demanding their own treatments and consequences in terms of lost work time, impaired work, accidents, etc that add to the cost. It does, of course, presume that we have an effective treatment, which with CPAP is decidedly the case, to an extent exceeding that of most drug treatments for medical illness, and that it does not cost an extraordinary amount. You may think that a sleep study, which may run up to $2000 and a CPAP machine, which may cost another $2000, are high, but you should consider how many thousands the least expensive types of surgery cost, let alone the ultraexpensive transplant procedures. Even a medication, if new and therefore under patent and expensive, may easily cost $1.50 for a single pill of the sort one takes a few times a day forever, let alone the extraordinary costs of specialized drug treatments for cancer, multiple sclerosis, etc. In contexts like these, CPAP is not remarkably expensive, and it is remarkably effective, with very widespread benefits for people who usually have many years of fruitful function (or potential disability) ahead of them.
WHAT DO YOU THINK ABOUT THIS ARTICLE AND MY COMMENTS?
CAN YOU RELATE THIS MATERIAL TO ANY PERSONAL EXPERIENCES?
PLEASE DON'T TAKE THAT INVITATION AS MERE COURTESY. THE BIG ADVANTAGE OF THE INTERNET IN CONVEYING INFORMATION LIES IN ITS INTERACTIVE ELEMENT, AND ESTABLISHING DIALOGUE IS A MAJOR GOAL AT THIS SITE--YOUR COMMENTS WILL BE READ, RESPONDED TO, AND QUITE LIKELY POSTED!
Get your own Free Home Page