Open AccessMedicare Long-Term CPAP Coverage Policy: A Cost-Utility Analysis
Author(s) -
Martha E. Billings,
Vishesh K. Kapur
Publication year - 2013
Publication title -
journal of clinical sleep medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.529
H-Index - 92
eISSN - 1550-9397
pISSN - 1550-9389
DOI - 10.5664/jcsm.3074
Subject(s) - medicine , reimbursement , polysomnogram , cost–benefit analysis , actuarial science , population , cost effectiveness , time horizon , quality adjusted life year , health policy , health care , intensive care medicine , public health , environmental health , risk analysis (engineering) , economics , finance , polysomnography , nursing , ecology , apnea , psychiatry , biology , economic growth
CPAP is an effective treatment for OSA that may reduce health care utilization and costs. Medicare currently reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. If not, Medicare requires a repeat polysomnogram (PSG) and another trial which seems empirically not cost-effective. We modeled the cost-effectiveness of current Medicare policy compared to an alternative policy (clinic-only) without the adherence criterion and repeat PSG.
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