A cost-minimization study of telemedicine: The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome
In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telem...
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| Veröffentlicht in: | International journal of technology assessment in health care 2001, Vol.17 (4), p.604-611 |
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| container_title | International journal of technology assessment in health care |
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| creator | PELLETIER-FLEURY, Nathalie GAGNADOUX, Frédéric PHILIPPE, Carole RAKOTONANAHARY, Dominique LANOE, Jean-Louis FLEURY, Bernard |
| description | In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telemonitored polysomnography (TMpsg), a cost minimization study was performed.
In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed.
The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9-17.4) and in 23.4% (95% CI, 19.12-27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8-22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 < or = Hc/TMc < or = 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63).
Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy. |
| doi_str_mv | 10.1017/S0266462301107154 |
| format | Article |
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In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed.
The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9-17.4) and in 23.4% (95% CI, 19.12-27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8-22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 < or = Hc/TMc < or = 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63).
Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy.</description><identifier>ISSN: 0266-4623</identifier><identifier>EISSN: 1471-6348</identifier><identifier>DOI: 10.1017/S0266462301107154</identifier><identifier>PMID: 11758304</identifier><identifier>CODEN: IJTCEK</identifier><language>eng</language><publisher>Cambridge: Cambridge University Press</publisher><subject>Biological and medical sciences ; Cost Savings ; Costs ; Cross-Over Studies ; Diffusion of Innovation ; Electrodiagnosis. Electric activity recording ; France ; Health Care Costs - classification ; Health Care Costs - statistics & numerical data ; Health Resources - economics ; Health Resources - utilization ; Home Care Services - economics ; Hospital costs ; Hospitals ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Laboratories ; Laboratories, Hospital - economics ; Medical sciences ; Nervous system ; Patients ; Performance evaluation ; Polysomnography - economics ; Polysomnography - methods ; Prospective Studies ; Sleep apnea ; Sleep Apnea, Obstructive - diagnosis ; Technology Assessment, Biomedical - economics ; Telemedicine ; Telemedicine - economics ; Telemetry - economics ; Travel - economics</subject><ispartof>International journal of technology assessment in health care, 2001, Vol.17 (4), p.604-611</ispartof><rights>2002 INIST-CNRS</rights><rights>2001 Cambridge University Press</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13382090$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11758304$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>PELLETIER-FLEURY, Nathalie</creatorcontrib><creatorcontrib>GAGNADOUX, Frédéric</creatorcontrib><creatorcontrib>PHILIPPE, Carole</creatorcontrib><creatorcontrib>RAKOTONANAHARY, Dominique</creatorcontrib><creatorcontrib>LANOE, Jean-Louis</creatorcontrib><creatorcontrib>FLEURY, Bernard</creatorcontrib><title>A cost-minimization study of telemedicine: The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome</title><title>International journal of technology assessment in health care</title><addtitle>Int J Technol Assess Health Care</addtitle><description>In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telemonitored polysomnography (TMpsg), a cost minimization study was performed.
In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed.
The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9-17.4) and in 23.4% (95% CI, 19.12-27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8-22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 < or = Hc/TMc < or = 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63).
Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy.</description><subject>Biological and medical sciences</subject><subject>Cost Savings</subject><subject>Costs</subject><subject>Cross-Over Studies</subject><subject>Diffusion of Innovation</subject><subject>Electrodiagnosis. Electric activity recording</subject><subject>France</subject><subject>Health Care Costs - classification</subject><subject>Health Care Costs - statistics & numerical data</subject><subject>Health Resources - economics</subject><subject>Health Resources - utilization</subject><subject>Home Care Services - economics</subject><subject>Hospital costs</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Laboratories</subject><subject>Laboratories, Hospital - economics</subject><subject>Medical sciences</subject><subject>Nervous system</subject><subject>Patients</subject><subject>Performance evaluation</subject><subject>Polysomnography - economics</subject><subject>Polysomnography - methods</subject><subject>Prospective Studies</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - diagnosis</subject><subject>Technology Assessment, Biomedical - economics</subject><subject>Telemedicine</subject><subject>Telemedicine - economics</subject><subject>Telemetry - economics</subject><subject>Travel - economics</subject><issn>0266-4623</issn><issn>1471-6348</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNplkUFP3DAQha2qqCzQH9BLZVWCW6jHduKkN4SgrYTEoXCOHMcBo8ROPQ5SuPWf49WuitSe5vC-eZo3j5BPwM6Bgfr6i_GqkhUXDIApKOU7sgGpoKiErN-TzVYutvohOUJ8YgwEa9gHcgigylowuSF_LqgJmIrJeTe5F51c8BTT0q80DDTZ0U62d8Z5-43ePVpqNNq_SvAuhWh7OodxxTD58BD1_LjSFGjv9IMPW7jDFBeT3LOlOFo7Uz17qymuvo9hsifkYNAj2o_7eUzur6_uLn8UN7fff15e3BQGSiFzjEqZLt8PWvW87HnXCJ4zmEbWZVmJmisxVKwGpaUsdVc1nVBGd8CYUVw24pic7XznGH4vFlM7OTR2HLW3YcFWcSEAGpnBL_-AT2GJPt_WcmCihJ0b7CATA2K0QztHN-m4tsDabTntf-Xknc9746XLX33b2LeRgdM9oNHocYjaG4dvnMgpc4HiFePults</recordid><startdate>2001</startdate><enddate>2001</enddate><creator>PELLETIER-FLEURY, Nathalie</creator><creator>GAGNADOUX, Frédéric</creator><creator>PHILIPPE, Carole</creator><creator>RAKOTONANAHARY, Dominique</creator><creator>LANOE, Jean-Louis</creator><creator>FLEURY, Bernard</creator><general>Cambridge University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7U5</scope><scope>7WY</scope><scope>7WZ</scope><scope>7X7</scope><scope>7XB</scope><scope>87Z</scope><scope>88C</scope><scope>88E</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FL</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BEZIV</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FRNLG</scope><scope>FYUFA</scope><scope>F~G</scope><scope>GHDGH</scope><scope>H94</scope><scope>K60</scope><scope>K6~</scope><scope>K9.</scope><scope>KB0</scope><scope>L.-</scope><scope>L7M</scope><scope>M0C</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQBIZ</scope><scope>PQBZA</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>2001</creationdate><title>A cost-minimization study of telemedicine: The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome</title><author>PELLETIER-FLEURY, Nathalie ; GAGNADOUX, Frédéric ; PHILIPPE, Carole ; RAKOTONANAHARY, Dominique ; LANOE, Jean-Louis ; FLEURY, Bernard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1534-4667cb3091a7d25d2b932830c94855638273f60817a445ab69b37cab100c72493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Biological and medical sciences</topic><topic>Cost Savings</topic><topic>Costs</topic><topic>Cross-Over Studies</topic><topic>Diffusion of Innovation</topic><topic>Electrodiagnosis. Electric activity recording</topic><topic>France</topic><topic>Health Care Costs - classification</topic><topic>Health Care Costs - statistics & numerical data</topic><topic>Health Resources - economics</topic><topic>Health Resources - utilization</topic><topic>Home Care Services - economics</topic><topic>Hospital costs</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Laboratories</topic><topic>Laboratories, Hospital - economics</topic><topic>Medical sciences</topic><topic>Nervous system</topic><topic>Patients</topic><topic>Performance evaluation</topic><topic>Polysomnography - economics</topic><topic>Polysomnography - methods</topic><topic>Prospective Studies</topic><topic>Sleep apnea</topic><topic>Sleep Apnea, Obstructive - diagnosis</topic><topic>Technology Assessment, Biomedical - economics</topic><topic>Telemedicine</topic><topic>Telemedicine - economics</topic><topic>Telemetry - economics</topic><topic>Travel - 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Academic</collection><jtitle>International journal of technology assessment in health care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>PELLETIER-FLEURY, Nathalie</au><au>GAGNADOUX, Frédéric</au><au>PHILIPPE, Carole</au><au>RAKOTONANAHARY, Dominique</au><au>LANOE, Jean-Louis</au><au>FLEURY, Bernard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A cost-minimization study of telemedicine: The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome</atitle><jtitle>International journal of technology assessment in health care</jtitle><addtitle>Int J Technol Assess Health Care</addtitle><date>2001</date><risdate>2001</risdate><volume>17</volume><issue>4</issue><spage>604</spage><epage>611</epage><pages>604-611</pages><issn>0266-4623</issn><eissn>1471-6348</eissn><coden>IJTCEK</coden><abstract>In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telemonitored polysomnography (TMpsg), a cost minimization study was performed.
In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed.
The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9-17.4) and in 23.4% (95% CI, 19.12-27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8-22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 < or = Hc/TMc < or = 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63).
Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy.</abstract><cop>Cambridge</cop><pub>Cambridge University Press</pub><pmid>11758304</pmid><doi>10.1017/S0266462301107154</doi><tpages>8</tpages></addata></record> |
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| ispartof | International journal of technology assessment in health care, 2001, Vol.17 (4), p.604-611 |
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| source | MEDLINE; Cambridge University Press Journals Complete |
| subjects | Biological and medical sciences Cost Savings Costs Cross-Over Studies Diffusion of Innovation Electrodiagnosis. Electric activity recording France Health Care Costs - classification Health Care Costs - statistics & numerical data Health Resources - economics Health Resources - utilization Home Care Services - economics Hospital costs Hospitals Humans Investigative techniques, diagnostic techniques (general aspects) Laboratories Laboratories, Hospital - economics Medical sciences Nervous system Patients Performance evaluation Polysomnography - economics Polysomnography - methods Prospective Studies Sleep apnea Sleep Apnea, Obstructive - diagnosis Technology Assessment, Biomedical - economics Telemedicine Telemedicine - economics Telemetry - economics Travel - economics |
| title | A cost-minimization study of telemedicine: The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome |
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