For years we have witnessed with interest the debate in the developed countries on the In-lab versus home sleep studies. We have heard the arguments both for and against each of these sleep diagnostic pathways. Essentially this has hinged on the merits of having an attended versus unattended sleep study.
An in-lab sleep study or in other words Level 1 Sleep study requires the patient to come to a sleep lab and his sleep is monitored throughout the night by a trained sleep technician who ensures that the data quality is good and there is direct observation of the problem in sleep and there is an opportunity to address the problem in other words manual CPAP titration can be done if a the need is felt for the same. The cost has been the major argument against this and at most places the physician now needs to justify to the insurance/reimbursement agencies about the need of using this pathway.
Level 2 or the home sleep testing is much cheaper however there is potential loss of data and manual titration is not possible. The very high prevalence of sleep apnea in the communities translates into massive public health issues which merits the use of simpler more cost effective strategies like this and even simpler tools like the Level 3 devices to address the same.
In India the insurance does not cover anything to do with sleep so we don’t have to justify anything to anybody except the patient themselves who expect complete value for money that they are spending from their pocket. Vested interests have ensured that the big public health reimbursement schemes like ECHS and CGHS do not properly cover the sleep diagnostics. Therefore we have no choice but have a strategy which is both cost effective and accurate. We do not have the luxury or the opportunity to repeat a sleep study just in case things go well in the first instance. Neither is it easy for us to device different levels of sleep testing ie to have screening sleep tests followed by a formal test later on as the patient will not see the value for money in this.
We are also a country with a ‘demographic dividend’ in other words large talented manpower pool. This has helped us devise our own pathway of “fully attended home sleep tests”. This means our trained sleep techs that stay overnight at patient’s place and ‘conduct’ fully attended sleep study. This does not strictly fit in with the traditional classification of sleep studies but it I guess we could classify it as Level 1 B.
Aviss Health (Sleep Cure Solutions) has the experience of doing thousands of these sleep tests without much issues. Needless to say that not all patients shall be suitable for this and some may require an in-lab sleep study. Only in about 2% instances we have had to repeat the sleep study for issues like power failure, electrical interference and other technical reasons.
This pathway is now firmly established here and is one of the most cost effective sleep diagnostic pathways anywhere in the world. It is high time that the insurance industry looks at it and covers this not only in the best interest of the patients but also their own future financial interest. This step shall also help to bring regulation & sanity in this completely unregulated market.
At Aviss Health(Sleep Cure Solutions) we take pride to be at the forefront of this evolution and also of devising a unique business model which further decreases the costs makes it even more cost-effective for our patients. This has helped us establish ourselves as a credible pillar in this highly unregulated market.