References

Wolford LM, Karras SC: Autologous fat transplantation around tem-poromandibular joint total joint prostheses: Preliminary treatment out-comes. J Oral Maxillofac Surg. 55:245; 1997

Binkert CM, Demetriou, et al: Regulation of osteogenesis by fetuin.J Biol Chem. 274:28514, 1999

Funding Source: University of Toronto.

The Cost of Sleep Apnea: The FinancialImplications of Surgical Treatment forObstructive Sleep ApneaMarshall Kurtz, DMD, 39 Hemingway Street,Pittsburgh, PA 15213 (Liberto F; Dattilo D)

Purpose: Untreated obstructive sleep apnea (OSA)leads to a significant increase in health care expendi-tures. The increased costs are linked to multiple chronicmedical conditions such as hypertension, stroke, depres-sion, and diabetes. There are also indirect costs associ-ated with excessive daytime sleepiness, increased motorvehicle and workplace accidents, and a decrease in workproduction. A review of the literature did not reveal anyprevious studies on the health economics of obstructivesleep apnea surgery. Surgical treatment of OSA over thelast decade has shown to produce an 81% to 100%success rate as measured by various parameters. Thepurpose of this paper is to retrospectively evaluate thehealth care costs involved in the surgical treatment ofOSA. These costs will be discussed in relation to nCPAPand untreated OSA patients. These costs will also becompared to other commonly performed orthopedicprocedures.

Patients and Methods: The financial records of 81patients with OSA treated by the same oral and maxillo-facial surgeon, at the same tertiary care institution, overa 3-year span were obtained. The patient population wasseparated into those receiving genioglossus advance-

ment and other upper airway procedures (phase I, 52patients) or those receiving maxillomandibular advance-ment (phase II, 29 patients). The records were evaluatedfor length of stay, DRG weights, and the hospital expen-ditures for salary/benefits, drugs/supplies, and other di-rect and indirect costs. Cost centers were examinedincluding OR/anesthesia/PACU, floor unit, pharmacy,and other miscellaneous costs. The same analysis wascompleted for 2 common orthopedic DRGs over the3-year span. Cost estimates relating to nCPAP and un-treated patients were obtained through a review of theliterature.

Results: The total direct cost per patient was $3,888for phase I and $6,772 for phase II. The net revenuereceived per patient for phase I was $7,351 and $9,455for phase II. This included hospital charges and reim-bursements only, and no physician charges or reimburse-ments. The reimbursements represented a payer mix of8 different carriers common to the region. The averagelength of stay for phase I and phase II was 1.6 and 2.4,respectively. The OR/anesthesia/PACU charges were, asanticipated, the largest percentage of the expenditures.

Conclusions: The cost of OSA surgery is significant.However, it compares favorably to many other commonsurgical procedures. It may be medically and financiallybeneficial to the patients, insurers, and hospitals to con-sider OSA surgery, especially accounting for the cost andcompliance issues of CPAP and untreated OSA. A surgi-cal treatment may be an advantageous choice for thepatient and represents a financially sound option from amedical economics viewpoint.

References

Rodenstein DO: Sleep apnoea syndrome: The health economicspoint of view. Mondali Arch Chest Dis 55:404, 2000

Waite P, Vilos G: Surgical changes of posterior airway space inobstructive sleep apnea. Oral Maxillofac Surg Clin North Am 14:385,2002

Oral Abstract Session 3: TMJ/Reconstruction/Pathology/Nerve Repair/Wound Repair/Miscellaneous

58 AAOMS • 2003