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Study Objectives: <p>Obstructive 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.</p> Methods: <p>A 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.</p> Results: <p>A 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.</p> Conclusions: <p>Using the screening model as a triage tool for PSG enhances the cost-effectiveness of pediatric OSA management.</p> Citation: <p>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. <i>J Clin Sleep Med</i>. 2025;21(4):655–665.</p>

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Cost-utility analysis of a tiered diagnostic approach combining a screening model and polysomnography in pediatric obstructive sleep apnea

  • 期刊论文

  • 发表日期：

    2025年4月1日

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  • Shenglong Xu,
  • Yanru Li,
  • Demin Han

摘要

Study Objectives:

Obstructive 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.

Methods:

A 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.

Results:

A 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.

Conclusions:

Using 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. J Clin Sleep Med. 2025;21(4):655–665.