OBJECTIVES: To assess the economic and environmental impact of introducing auto-PAP (APAP) with telemonitoring (TM) in the home of the patient for PAP initiation and therapy follow-up from a German payer perspective.

METHODS: A deterministic decision-tree was implemented in Excel considering OSA differential diagnostics, PAP therapy initiation and therapy follow-up at around six months. The SOC pathway was implemented according to the directive on sleep disordered breathing issued by the German Federal Joint Committee. Based on a systematic literature review, the APAP pathway was developed with transition probabilities. PSG, therapy follow-up and PAP devices costs were based on official German reimbursement catalogues. German governmental publications were used to estimate CO2 emissions along the patient pathway.

RESULTS: In the base case 80% of patients were eligible for APAP initiation and 75% of patients were able to be followed-up by telemonitoring and therefore avoid a follow-up visit to the sleep laboratory. Mean costs per patient amounted to 562 EUR in the new APAP pathway and to 1,103 EUR in the SOC pathway. CO2 footprint for visits to the sleep laboratory was 1.5 kg for the new APAP pathway with telemonitoring and 3.7 kg in the SOC pathway.

CONCLUSIONS: Introducing a new home-based therapy initiation with APAP and telemonitoring in Germany would be feasible from an economic perspective. The new pathway would save 541 EUR, mostly due to saved PSG nights (saving 49% of SOC total costs), and reduce CO2 emissions by 2.2 kg due to saved visits to the sleep laboratory (saving 59% of total CO2 emissions for visits to the sleep laboratory in SOC pathway).