The economic burden of medical care in general and sleep apnea syndrome in particular

Healthcare spending in the U.S. has been growing steadily for the last 30 years, at a rate 2% faster than the rest of the economy. The rising costs of healthcare have had its toll on individuals’ and the nation’s finances. Nearly a half-million people file for bankruptcy every year because of high medical costs. In 2007, the total U.S. healthcare bill came to $2.3 trillion—more than was spent on food in the same year. Despite this relatively high level of spending, the U.S. does not appear to provide substantially greater health resources to its citizens, or achieve substantially better health benchmarks, compared to other developed countries [1]. As has been clear for the last 10 years, it is high time to reform our healthcare delivery system, to make it more effective and efficient. Systematic economic analyses of healthcare delivery are and will be a valuable tool in reshaping our healthcare system. Alongside research that provides the evidence to base medical decision-making should be the research that determines the cost impact of the medical decisions. Many of our current healthcare policies and practices in medicine are guided by consensus opinion, instead of informed economic analyses. Such analyses require data on the scope, the consequences, and the costs of a medical disorder. Obstructive sleep apnea (OSA) is a disorder that has been increasingly identified as one that is highly prevalent, has significant impact on quality of life, is a risk factor for multiple co-morbid conditions and increased mortality, and is relatively simple to treat. Our imperative in the Sleep Medicine community is to convince policy makers that allocating resources to the diagnosis and treatment of OSA will have a substantial positive impact, both on medical outcomes and overall medical costs [2]. Treatment of sleep apnea syndrome (SAS), defined as OSA with clinical sleepiness, is both economical and effective. A number of studies have supported the economic benefits of treating SAS, particularly when comparing the incremental costs of treatment with CPAP per quality adjusted life years. When quality of life, costs of therapy, and motor vehicle outcomes are considered, CPAP therapy for patients with SAS is attractive for both economics and the health benefits [3, 4]. These studies do not address the potential benefits of future medical cost savings due to improved health status and reduction of co-morbidities. The economical benefits of CPAP may prove to be even more advantageous in subsets of patients who may be more vulnerable to the complications of SAS. While current medical literature justifies the treatment of all patients with SAS, limited healthcare resources may be best allocated to the subsets of patients that may benefit most from the diagnosis and treatment. Patients with obstructive lung disease, such as chronic obstructive pulmonary disease (COPD) and asthma, may be disproportionately affected by the presence of SAS. Patients with concomitant COPD and SAS have been shown to have more frequent nocturnal desaturations and sleep fragmentation [5]. In patients with severe asthma and OSA, treatment of the OSA with CPAP has been shown to significantly improve nocturnal asthma symptoms, also suggesting an interaction between the two disorders [6, 7]. There is sufficient reason to believe that the presence of SAS in patients with obstructive lung disease may worsen health status and increase the healthcare needs of these