Home vs inpatient CPAP titration costs in OSA patients from Southern Italy: the role of telemedicine

Background: considering high prevalence and burden of obstructive sleep apnoea (OSA), effective diagnostic and treatment strategies are needed to minimize the negative health impacts and to maximize cost–effectiveness (Lugo VM et al. PLoS ONE 14(10):e0224069). Aims: to compare the costs, in terms of health expenditure, of home Continuous Positive Airway Pressure (CPAP) titration with a telemedicine system with respect to a hospital procedure. Methods: we conducted a prospective study on 31 patients (pts) affected by moderate or severe OSA (AHI>15), matched for anthropometric and clinical parameters. They were divided into 2 groups: pts who underwent home CPAP titration using a telemedicine system (group A), and pts referred to an inpatient sleep lab titration (group B). For each group we evaluated costs related to the titration procedure. Variables were compared with Student’s T-Test. Results: 15 pts were included in group A and 16 pts in group B. For home CPAP titration we considered costs related to equipment (APAP device with a remote monitoring system and material replacements), procedures (polysomnography) and working hours dedicated to the pts by the medical staff involved, for a total of 294.12€ per patient. For hospital titration, the total cost per patient was calculated based on the Diagnosis-Related Group (DRG) number 73 (annex 1, decree of the Ministry of Health, 18 October 2012, Italian National Health Service) and it amounts to about 1186€. Comparison between the groups showed a net saving of 75% in the home CPAP titration group. Conclusions: telemedicine is a useful tool for OSA management, facilitating access to healthcare and reducing expenditures.