Positioning Primary Care at the Centre of Sleep Health Management: A Health Economics Approach

Author: Andrea Natsky

  • Thesis download: available for open access on 28 Aug 2026.

Natsky, Andrea, 2023 Positioning Primary Care at the Centre of Sleep Health Management: A Health Economics Approach, Flinders University, College of Medicine and Public Health

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Sleep is an integral part of our daily lives. Disruption of sleep due to clinical sleep disorders and socially driven sleep restrictions significantly impact the economy and overall wellbeing. Two of the most common and severe sleep disorders contributing substantial economic costs are obstructive sleep apnoea (OSA) and insomnia. Although the health care system plays a crucial role in managing sleep disorders, the current health services are complex, misdirected and expensive to effectively manage the burden of sleep problems in the community. The current dependence on specialist health services suggests that the societal burden of sleep disorders remains mainly unmet, negatively impacting health, productivity, and safety. Alternatively, primary care is readily available, accessible, and strategically placed at the front line of health care delivery. Transitioning the focus from specialist services to primary care seems logical. However, myriads of challenges and uncertainties remain. The National Centre for Sleep Health Services Research (NCSHSR) examines these comprehensive issues, aiming to position primary care at the centre of sleep health management (1). The NCSHSR, founded in 2018, is a National Health and Medical Research Council (NHMRC) Centres of Research Excellence, involving several Australian universities, professional organisations, industry partners, research scientists, sleep physicians and primary care health care professionals. This thesis contributes to the extensive research effort of NCSHSR by applying a health economic approach to issues on sleep disorders.

Beneath the overarching aim of health economics application in the scope of sleep health, there are four main areas that this thesis aims to make a specific contribution to: evaluate the cost-effectiveness of Cognitive Behaviour Therapy (CBT-I) in lieu of hypnotic medications for insomnia (Chapter 2); assess and conduct economic evaluation evidence of limited channel diagnostic tests for OSA compared to polysomnography (Chapter 3 and 4); provide empirical evidence of people’s preferences and prioritisation regarding OSA care pathways (Chapter 5); and present a mapping algorithm to predict generic utilities from a sleep specific quality-of-life (QoL) instrument (Chapter 6). The thesis employs five pragmatic applications of health economics approaches in five distinct chapters to add value to current decision-making in health practice, policy, and research by establishing evidence-based and cost-effective sleep health services in the primary care setting. Salient methodologies, including systematic reviews, economic evaluation, discrete choice experiments, and mapping functions, are incorporated in each chapter as each has a standalone nature and focus while still being connected under the umbrella of practical health economics application in sleep health.

The main findings in the thesis support the broad research effort in transitioning and positioning primary care at the centre of sleep health management. Robust and reliable cost-effectiveness evidence is required to guide decision-making bodies to allocate scarce healthcare resources effectively and efficiently. In Chapters 2-4, we found using CBT-I and limited channel diagnostic tests to be cost-effective relative to usual practice. These findings were supported by the preference of individuals who prefer to have OSA management in primary care. Given the limited number of economic studies on sleep health, the novel findings and methodologies used in this thesis highlight the potential and usefulness of health economic approaches in addressing and advancing pertaining issues in sleep health.

Keywords: health economics, economic evaluation, sleep health, insomnia, sleep apnoea, systematic reviews, discrete choice experiment, quality of life

Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Medicine and Public Health
Supervisor: Billingsley Kaambwa