Investing in Diagnosis: Health Economic Value of Early Obstructive Sleep Apnea Detection for Private Insurers in India
Author(s)
Ankit Ghildiyal, M.Pharm, MSc1, Sibasish Dey, MD2, Upasana Kharb, MBA2.
1ResMed, Oxfordshire, United Kingdom, 2ResMed, Delhi, India.
1ResMed, Oxfordshire, United Kingdom, 2ResMed, Delhi, India.
OBJECTIVES: Obstructive Sleep Apnea (OSA) remains significantly underdiagnosed in India, with approximately 85% of cases going undetected. This underdiagnosis contributes to avoidable downstream costs, including increased ICU admissions, cardiovascular events, and diabetes-related complications. Despite these implications, OSA diagnosis is predominantly financed out-of-pocket, limiting private insurers' incentives to invest in early detection. This study aims to evaluate the economic value of early OSA diagnosis for private insurers in India and to identify the population segments and diagnostic deployment strategies that yield the highest return on investment (ROI) and overall system value.
METHODS: We have conducted a one-time static analysis, supplemented by a three-year risk escalation model, to compare diagnosed versus undiagnosed individuals. This evaluation is based on India-specific data and assesses clinical and economic outcomes across varying risk profiles, age groups, disease severities, and diagnostic settings (home-based vs. hospital-based).
RESULTS: Early diagnosis demonstrated a positive ROI across all high-risk groups. A base-case scenario showed a 25% ROI, with hospitalization cost reductions of up to 90%. ROI rose to 180% when focusing on adults over 50 with severe OSA. Cost avoidance per patient improved by 21% in these higher-risk cohorts. Over a 3-year horizon, early diagnosis became even more cost-efficient in scenarios where hospitalisation risk increased by 10-20%, with ROI reaching 280-360%. Hospital-based diagnostics significantly reduced efficiency—net benefit dropped by 40-50% as the diagnostic share shifted from 20% to 80%, favouring community-based pathways.
CONCLUSIONS: Early OSA diagnosis delivers meaningful economic returns for private insurers, particularly when targeted to high-risk populations and delivered via decentralised pathways. These results support a proactive care model that enhances payer efficiency, reduces preventable events, and strengthens long-term financial sustainability.
METHODS: We have conducted a one-time static analysis, supplemented by a three-year risk escalation model, to compare diagnosed versus undiagnosed individuals. This evaluation is based on India-specific data and assesses clinical and economic outcomes across varying risk profiles, age groups, disease severities, and diagnostic settings (home-based vs. hospital-based).
RESULTS: Early diagnosis demonstrated a positive ROI across all high-risk groups. A base-case scenario showed a 25% ROI, with hospitalization cost reductions of up to 90%. ROI rose to 180% when focusing on adults over 50 with severe OSA. Cost avoidance per patient improved by 21% in these higher-risk cohorts. Over a 3-year horizon, early diagnosis became even more cost-efficient in scenarios where hospitalisation risk increased by 10-20%, with ROI reaching 280-360%. Hospital-based diagnostics significantly reduced efficiency—net benefit dropped by 40-50% as the diagnostic share shifted from 20% to 80%, favouring community-based pathways.
CONCLUSIONS: Early OSA diagnosis delivers meaningful economic returns for private insurers, particularly when targeted to high-risk populations and delivered via decentralised pathways. These results support a proactive care model that enhances payer efficiency, reduces preventable events, and strengthens long-term financial sustainability.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD65
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)