OBJECTIVES:Obstructive Sleep Apnea (OSA) is highly prevalent though under recognized public health problem in India.OSA is often undiagnosed especially in rural areas where 70% of the population resides in India. The increasing prevalence of SDB and a greater awareness of the associated health risk, have resulted in a high demand of testing for sleep studies. Therefore, the objective is to assess Cost Effectiveness of Polysomnography (Level I) and Portable Device (Level III) for the Diagnosis of Sleep Disorder Breathing in Indian population.

METHODS: A decision analytic model was built in Excel, comparing Level I, Level III and doing nothing at first level using 1 year time horizon with societal perspective in India was carried out to provide evidence based on the economic evaluation. For analysis through decision analytic model excel was used. For diagnostic accuracy parameter meta-analysis was also performed through Bivariate mixed-effects binary regression model used to estimate summary diagnostic accuracy parameters suing Revman 5.3 & STATA 14 using Revman 5.3 and STATA 14. The protocol was published in PROSPERO database(CRD42018110619).

RESULTS: The incremental cost effectiveness analysis of OSA screening compared with do nothing were calculated as INR 76,662.60 per quality adjusted life year (QALY). Taking the threshold to from World Health Organization (WHO) according to which if the ICER value is less than 1 GDP then the intervention technology is cost effective. Therefore, level III screening is very cost effective as ICER is less than 1 GDP (as per WHO Threshold level).

CONCLUSIONS: Diagnosis of OSA with Level III is a feasible and acceptable alternative in the rural population. The screening is very cost effective with Level III study. OSA is underdiagnosed in rural populations, although risk factors are present. Training community health workers to administer Level III sleep study is a feasible approach.