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Volume 14 No. 06
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Accepted Papers

Scientific Investigations

Cost-Effectiveness Analysis of the DiagnOSAS Screening Tool Compared With Polysomnography Diagnosis in Dutch Primary Care

Floris A.J. Geessinck, MSc1; Rick G. Pleijhuis, MD, PhD2; Rob J. Mentink, Eng PhD3; Job van der Palen, PhD4; Hendrik Koffijberg, PhD5
1Master Program Health Sciences, University of Twente, Enschede, The Netherlands; 2Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands; 3Evidencio, Haaksbergen, The Netherlands; 4Faculty of Behavioural, Management and Social Sciences, Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; 5Faculty of Behavioural, Management and Social Sciences, Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands

Study Objectives:

The growing recognition of obstructive sleep apnea (OSA) as a serious health condition, increasing waiting lists for sleep tests, and a high proportion of unnecessary referrals from general practice highlight the need for alternative diagnostic strategies for OSA. This study's objective was to investigate the cost-effectiveness of DiagnOSAS, a screening tool that strives to facilitate fast and well-informed referral to hospitals and sleep clinics for diagnosis, in The Netherlands.


A Markov model was constructed to assess cost-effectiveness in men aged 50 years. The diagnostic process of OSA was simulated with and without DiagnOSAS, taking into account the occurrence of hazardous OSA effects: car accidents, myocardial infarction, and stroke. The cost-effectiveness of “DiagnOSAS Strategy” and a “Rapid Diagnosis Scenario,” in which time to diagnosis was halved, was assessed.


Base case results show that, within a 10-year time period, DiagnOSAS saves €226 per patient at a negligible decrease (< 0.01) in quality-adjusted life-years (QALYs), resulting in an incremental cost-effectiveness ratio of €56,997/QALY. The “Rapid Diagnosis Scenario” dominates usual care (ie, is both cheaper and more effective). For a willingness-to-pay threshold of €20,000/QALY the probability that the “DiagnOSAS Strategy” and “Rapid Diagnosis Scenario” are cost-effective equals 91.7% and 99.3%, respectively.


DiagnOSAS appears to be a cost-saving alternative for the usual OSA diagnostic strategy in The Netherlands. When DiagnOSAS succeeds in decreasing time to diagnosis, it could substantially improve health outcomes as well.


Geessinck FAJ, Pleijhuis RG, Mentink RJ, van der Palen J, Koffijberg H. Cost-effectiveness analysis of the DiagnOSAS screening tool compared with polysomnography diagnosis in Dutch primary care. J Clin Sleep Med. 2018;14(6):1005–1015.

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