Budget Impact of Replacing In-Laboratory Polysomnography With Comprehensive Home Polysomnography Using the Onera Sleep Test System in a U.S. Commercial Health Plan
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Background
In-laboratory polysomnography (PSG) remains the diagnostic reference standard for sleep disorders but is resource-intensive and capacity-constrained. Limited-channel home sleep apnea testing (HSAT) improves access and reduces costs compared to in-laboratory polysomnography, but underestimates disease severity due to its inability to measure true sleep time and cannot identify non-respiratory sleep disorders including periodic limb movement disorder and parasomnias. 1–5 Comprehensive home polysomnography (hPSG) may preserve diagnostic fidelity while reducing system costs, improving access for patients unable to attend laboratory-based studies, and shortening time to diagnosis and therapy initiation.
Objective
To estimate the short-term budget impact to a U.S. commercial health plan of substituting an appropriately selected proportion of in-laboratory PSG with comprehensive hPSG using the Onera Sleep Test System (STS).
Methods
We developed a transparent budget impact model following ISPOR good practice guidelines for a hypothetical 1-million-member commercial plan. The model estimates the annual diagnostic population (top-of-funnel) using age- and sex-stratified prevalence, an undiagnosed fraction of 85%, symptom prevalence among undiagnosed individuals (30%), and an annual testing rate (12%). 2–3 Baseline costs reflect current diagnostic pathways using HSAT (50% first-line) and in-laboratory PSG (50% first-line), including HSAT-to-PSG escalations (20%) and PSG repeats (4%). The intervention scenario substitutes a defined share of in-laboratory PSG and selected HSAT with Onera hPSG. Scenario and sensitivity analyses explore parameter uncertainty.
Results
In the base case, approximately 4,364 individuals entered the OSA diagnostic workflow annually. Baseline diagnostic costs were estimated at $6.23 PMPM, comprising $5.45 million in PSG costs and $0.79 million in HSAT costs. Introducing Onera hPSG (30% PSG replacement, 5% HSAT replacement in Year 1) reduced per member costs to $5.66 PMPM, yielding net savings of $0.57 PMPM ($567,262 annually). In Year 3 scenarios (60% PSG, 10% HSAT replacement), savings increased to $1.64 PMPM (approximately $1.64 million annually). Sensitivity analyses demonstrated net savings ranging from $0.03 to $8.05 PMPM, depending on adoption levels.
Conclusions
Partial substitution of in-laboratory PSG with Onera hPSG may yield incremental budget savings for U.S. commercial payers while maintaining access to full polysomnographic assessment. Results support further payer-specific analyses incorporating real-world utilization and downstream outcomes.
