Cost-Effectiveness of Smartphone-Based Screening for Obstructive Sleep Apnea: A Markov Model Analysis From the German Statutory Health Insurance Perspective
Author(s)
Marcel Braun, MBA, MSc, PhD1, Till Erdmann, MBA2, Christoph Janott, PhD3, Ulrich J. Sommer, MD, PhD4, Clemens Heiser, MD, PhD4.
1Researcher, University Hospital Duisburg-Essen, Center for Sleep Medicine, Bonn, Germany, 2DIametos GmbH, Potsdam, Germany, 3Diametos GmbH, Potsdam, Germany, 4ENT Center Mangfall-Inn, Bad Aibling, Germany.
1Researcher, University Hospital Duisburg-Essen, Center for Sleep Medicine, Bonn, Germany, 2DIametos GmbH, Potsdam, Germany, 3Diametos GmbH, Potsdam, Germany, 4ENT Center Mangfall-Inn, Bad Aibling, Germany.
OBJECTIVES: Obstructive sleep apnea (OSA) affects up to 21% of the adult population, with up to 80% of cases remaining undetected due to limited access to diagnostic resources. Untreated OSA increases the risk of cardiovascular events, stroke, traffic accidents, and premature mortality, resulting in substantial health and economic burden. Snorefox-M is a clinically validated smartphone-based application that employs acoustic signals to identify OSA with 91% sensitivity and 83% specificity. This study assesses the cost-effectiveness of smartphone-based OSA screening relative to the absence of screening from the perspective of German statutory health insurance (SHI).
METHODS: A Markov state-transition model was constructed using a 9-state intervention pathway versus 4-state comparator, with gender-specific parameters and age-dependent mortality and morbidity risks. Individuals aged 50-60 were modeled over 10-year and lifetime horizons with 3% annual discounting. Outcomes included clinical events (MI, stroke, road traffic accidents), mortality, and quality-adjusted life years (QALYs) with state-specific utilities. German SHI costs included screening (€50), polysomnography (€378), treatment (€400 annually), and complications (€5,190-€13,257 per health state).
RESULTS: Screening was economically dominant for both genders over a 10-year horizon reducing costs by 17.6-17.9% and increasing QALYs by 19.8-20.3%. Incremental cost-effectiveness ratios (ICERs) were -€9,253 in females, and -€10,203 in males. Clinical events were reduced by 17-32% and mortality decreased by 26%. Over a lifetime horizon, ICERs remained highly favorable with €10,478/QALY and €8,900/QALY respectively, well below conventional €20,000 willingness-to-pay thresholds. Screening generated 5.4-6.0 additional QALYs per patient with substantial reductions in cardiovascular events and accidents.
CONCLUSIONS: Smartphone-based OSA screening demonstrates favorable cost-effectiveness with lifetime ICERs below standard thresholds and provides meaningful health benefits through prevention of downstream complications. These findings indicate that smartphone-based OSA screening merits consideration for population health programs, offering reasonable value by preventing cardiovascular events, accidents, and premature mortality while improving quality of life in middle-aged adults.
METHODS: A Markov state-transition model was constructed using a 9-state intervention pathway versus 4-state comparator, with gender-specific parameters and age-dependent mortality and morbidity risks. Individuals aged 50-60 were modeled over 10-year and lifetime horizons with 3% annual discounting. Outcomes included clinical events (MI, stroke, road traffic accidents), mortality, and quality-adjusted life years (QALYs) with state-specific utilities. German SHI costs included screening (€50), polysomnography (€378), treatment (€400 annually), and complications (€5,190-€13,257 per health state).
RESULTS: Screening was economically dominant for both genders over a 10-year horizon reducing costs by 17.6-17.9% and increasing QALYs by 19.8-20.3%. Incremental cost-effectiveness ratios (ICERs) were -€9,253 in females, and -€10,203 in males. Clinical events were reduced by 17-32% and mortality decreased by 26%. Over a lifetime horizon, ICERs remained highly favorable with €10,478/QALY and €8,900/QALY respectively, well below conventional €20,000 willingness-to-pay thresholds. Screening generated 5.4-6.0 additional QALYs per patient with substantial reductions in cardiovascular events and accidents.
CONCLUSIONS: Smartphone-based OSA screening demonstrates favorable cost-effectiveness with lifetime ICERs below standard thresholds and provides meaningful health benefits through prevention of downstream complications. These findings indicate that smartphone-based OSA screening merits consideration for population health programs, offering reasonable value by preventing cardiovascular events, accidents, and premature mortality while improving quality of life in middle-aged adults.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE275
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Disease
Neurological Disorders, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)