WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP REPORT BY ACCESS ECONOMICS PTY LIMITED FOR SLEEP HEALTH AUSTRALIA, OCTOBER 2004 WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP Acknowledgements & Disclaimer This report was prepared by Access Dr Mark Howard Economics for the steering committee of Department of Respiratory Medicine, Sleep Health Australia, a nascent national Austin Health, Victoria sleep health organisation. It was funded by Professor Colin Sullivan an unrestricted grant from the ResMed Department of Medicine, Foundation Limited who had no part in the University of Sydney direction or findings contained in this report. A/Prof John Wheatley Access Economics would like to acknowledge Director, Department of Respiratory with appreciation the comments, prior Medicine, Westmead Hospital research and expert input from: Mr John Goss Dr Ral Antic Head, Summary Measures Unit, Director of Thoracic Medicine, Australian Institute of Health and Welfare Royal Adelaide Hospital Information in Section 3.2 of this report has Dr David Hillman been drawn from data collected by the Head, Department of Pulmonary Physiology, General Practice Statistics and Classification Sir Charles Gairdner Hospital, Perth Unit, Department of General Practice, Additional assistance was provided by: University of Sydney in collaboration with the Australian Institute of Health and Welfare. A/Prof Peter Cistulli, Director, Department of Respiratory and Sleep Medicine, St George Hospital, Kogarah, NSW While every effort has been made to ensure the accuracy of this document, the uncertain nature of economic data, forecasting and analysis means that Access Economics Pty Limited is unable to make any warranties in relation to the information contained herein. Access Economics Pty Limited, its employees and agents disclaim liability for any loss or damage which may arise as a consequence of any person relying on the information contained in this document. WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP Table of Contents EXECUTIVE SUMMARY i 1. Literature Review 1 1.1. Prevalence and types of sleep disorders 1 1.1.1. One-year population prevalence estimate used in this report 3 1.2. Sleep disorders and other health conditions 3 1.2.1. Hypertension (high blood pressure) 4 1.2.2. Congestive heart failure 4 1.2.3. Coronary heart disease and myocardial infarction 5 1.2.4. Stroke 5 1.2.5. Cardiovascular diseases more generally 6 1.2.6. Diabetes 6 1.2.7. Depression 9 1.3. Sleep disorders and the risk of accidents 11 1.3.1. Motor vehicle accidents 11 1.3.2. Other accidents 14 1.4. Sleep disorders in children 15 1.5. Costs of sleep disorders 16 2. Attributable Fractions 18 2.1. Cardiovascular disease 18 2.2. Diabetes 20 2.3. Depression and other mental disorders 20 2.4. Injuries 21 2.4.1. Motor vehicle accidents 21 2.4.2. Workplace injuries 22 2.5. Childhood sleep disorders 23 3. Health costs of sleep disorders 24 3.1. Health expenditure directly on sleep disorders 25 3.2. BEACH data analysis 27 3.2.1. GP costs 27 3.2.2. Pharmaceutical costs 30 3.2.3. Pathology costs 30 3.2.4. Other costs 33 3.3. Summary of health costs of sleep disorders 34 3.4. Health spending on conditions associated with sleep disorders 35 3.5. Summary of health costs 39 WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP 4. Indirect costs of sleep disorders 40 4.1. Work related injuries 40 4.2. Road traffic accidents 41 4.3. Other production losses 42 4.3.1. Lower employment and productivity 43 4.3.2. Premature mortality 45 4.4. Other indirect costs 45 5. Burden of disease of sleep disorders 48 5.1. Suffering and premature death methodology 48 5.1.1. Valuing life and health 48 5.1.2. DALYs and QALYs 49 5.1.3. Discount rate 51 5.2. The burden of disease of sleep disorders 52 5.3. Cost of suffering from sleep disorders 56 6. Comparisons and opportunities 58 6.1. Summary of costs 58 6.2. Comparisons with Australian national health priorities 60 6.3. International developments 62 6.4. Opportunities for the future 62 Appendix A – Types and prevalence of sleep disorders 66 Appendix B – Health cost code allocations 76 Appendix C – RFEs and problems managed 80 References 82 WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP Tables Table 1-1 Prevalence of obstructive sleep apnoea from 3 similar studies 2 Table 1-2 Odds ratio of having OSA and hypertension 4 Table 1-3 Adjusted relative odds of prevalent cardiovascular disease 5 Table 1-4 Multivariate adjusted relative risk of Type II diabetes among women in the Nurses Health Study followed up 1986-1996, wrt history of snoring in 1986 7 Table 1-5 Baseline respiratory parameters and sleep architecture measures among adults at risk for CVD, by diabetes status, Sleep Heart Study 1995-1998 8 Table 1-6 Beck depression scale 9 Table 1-7 Prevalence of depressive feelings associated with specific sleep disorders (%) 9 Table 1-8 Relation of sleep complaints in 1994 & 1995 to major depressive episodes in 1995 in the Alameda County (California) Study 10 Table 1-9 Relationship between sleep apnoea and traffic accidents 13 Table 1-10 Stanford sleepiness scale 13 Table 1-11 Direct costs of insomnia in the United States for 1995 16 Table 2-1 The attributable burden of hypertension by condition, 1996 19 Table 2-2 Summary of attributable fractions for hypertension by condition 19 Table 2-3 Diabetes, attributable fractions 20 Table 2-4 Depression, attributable fractions 21 Table 2-5 Motor vehicle accidents, attributable fractions 22 Table 2-6 Workplace injuries, attributable fractions 23 Table 3-1 Health cost inflation, % per annum, Australia, 1991-92 to 2001-02 24 Table 3-2 GP costs, sleep disturbances 28 Table 3-3 Relative distribution of GP encounters for sleep disturbances 28 Table 3-4 Sleep disturbance encounters by age and gender of patient 28 Table 3-5 Problem management, sleep disturbances 29 Table 3-6 Sleep disturbances: top ten medication classes prescribed 30 Table 3-7 Pharmaceutical costs, sleep disturbances 31 Table 3-8 Pathology costs, sleep disturbances 32 Table 3-9 Diagnostic imaging costs, sleep disturbances 33 Table 3-10 Specialist and allied health costs, sleep disturbances 33 Table 3-11 Health costs, sleep disturbances 34 Table 3-12 Health costs of conditions associated with sleep disorders, 2004, scenario analysis 36 Table 3-13 Health costs of conditions associated with sleep disorders, 2004, by type of cost, scenario analysis 37 Table 3-14 Health costs attributable to sleep disorders, 2004, $m 39 Table 3-15 Health costs attributable to sleep disorders, 2004, $m, by who pays 39 Table 4-1 Cost of work-related injuries due to sleep disorders, $m, 2004 41 Table 4-2 Cost of road traffic accidents due to sleep disorders, $m, 2004 42 Table 4-3 Reduced employment due to sleep disorders & comorbid illnesses, 2004 43 Table 5-1 International estimates of VSL, various years 50 WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP Table 5-2 Burden of disease associated with sleep disorders, 2004, sensitivity analysis by YLL, YLD, gender & age 54 Table 5-3 Burden of disease associated with sleep disorders, 2004, sensitivity analysis by YLL, YLD, gender & condition 55 Table 5-4 Gross cost of suffering associated with sleep disorders, $m, 2004 56 Table 5-5 Net cost of suffering associated with sleep disorders, $m, 2004 57 Table 6-1 Summary of the costs of sleep disorders, $m, 2004 58 Table 6-2 Health cost comparison, national priorities & other, 2000-01, $m 60 Table C-1 Top 30 RFEs and total problems managed where sleep disturbance was at least one problem managed 81 Figures Figure 3-1 Inpatient costs, sleep disorders, 2004, $m, by condition 26 Figure 3-2 Inpatient costs sleep disorders, 2004, $m, by age & gender 26 Figure 3-3 Health costs of conditions associated with sleep disorders, 2004, $m 35 Figure 3-4 Health costs of conditions associated with sleep disorders, 2004, $m, by cost type 37 Figure 3-5 Health costs of conditions associated with sleep disorders, 2004, $m, by age and gender 38 Figure 3-6 Health costs of conditions associated with sleep disorders, 2004, $m, by age: high, mid and low scenarios 38 Figure 5-1 Burden of disease associated with sleep disorders, 2004, DALYs, by condition 52 Figure 5-2 Burden of disease associated with sleep disorders, 2004, YLL & YLD, by condition & gender 53 Figure 5-3 Burden of disease associated with sleep disorders, 2004, YLL & YLD by age 53 Figure 6-1 Composition of the costs of sleep disorders, $m, 2004 59 Figure 6-2 Comparison of disease burden - sleep disorders and selected others 61 Figure 6-3 Sleep disorders relative to other risks to health (% of total DALYs) 61 WAKE UP AUSTRALIA: THE VALUE OF HEALTHY SLEEP Executive Summary Sleep disorders are a large and under- rhythm disorders, sleep-related epilepsy, recognised problem in Australia. non-organic sleep-wake disorders, alcohol-dependent sleep disorders, • We estimate that over 1.2 million sleep-related asthma, insomnias Australians (6% of the population) (disorders of initiating and maintaining experience sleep disorders, with costs sleep), hypnotic and stimulant dependent of $10.3 billion in 2004. sleep disorders, and other specified • The most common disorder is Obstructive extrapyramidal and movement disorders Sleep Apnoea (OSA), affecting an (Periodic Limb Movement Disorder and estimated 4% of the population, although Restless Legs Syndrome). there are over 70 other different – 29% of inpatient costs relate to infant diagnosable sleep disorders. sleep disorders; there is a secondary – Insomnias are also highly prevalent, with prevalence mode in the prime working substantial morbidity and mortality.