ALLOCATING PROVIDER RESOURCES TO ACCURATELY DIAGNOSE AND TREAT RESTLESS LEGS SYNDROME: A COST-EFFECTIVENESS ANALYSIS

OBJECTIVES: Restless legs syndrome (RLS) is a neurological disorder that is frequently underdiagnosed and misdiagnosed. Patients exhibiting RLS symptoms are often initially misdiagnosed with peripheral neuropathy, anxiety, sleeping disorder, or deep venous thrombosis, resulting in delays in proper treatment. Our objective was to analyze the cost-effectiveness of training primary care physicians in early and accurate diagnosis of RLS. METHODS: We used a Markov model to compare two strategies: one where primary care providers receive training to diagnose RLS (informed care) and one where primary care providers do not receive training (standard care). This analysis was conducted from the U.S. societal perspective over 1, 5, and 50 years. Costs were adjusted to 2016 US dollars. Effectiveness was measured in units of quality-adjusted-life-years (QALYs). Costs and QALYs were discounted by 3%. Cost, utilities, and probabilities for the model were obtained through a comprehensive review of literature. An incremental cost-effectiveness ratio (ICER) was calculated to interpret our findings at a willingness-to-pay threshold of $100,000/QALY. Univariate and multivariate analyses were conducted, as was a probabilistic sensitivity analysis, to test model uncertainty. The Expected Value of Perfect Information was also calculated. RESULTS: In our lifetime model, providing training to primary care providers to correctly diagnose RLS was found to be cost-effective at willingness to pay (WTP) of $100,000 with an ICER of $4,593/QALY. The incremental cost for the informed care strategy was $2,021 per patient and the incremental effectiveness was 0.44 QALYs per patient. The model was sensitive to the utility for treated and untreated RLS. The probabilistic sensitivity analysis revealed that at the WTP threshold of $100,000, informed care had a 65.5% chance of being cost-effective. CONCLUSIONS: A program to train primary care providers to better diagnose RLS appears to be a cost-effective strategy for improving outcomes for patients suffering from RLS.