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An economic analysis of continuous positive airway pressure for the treatment of obstructive sleep apnea-hypopnea syndrome

Published online by Cambridge University Press:  06 January 2009

Helen L. A. Weatherly ,
Susan C. Griffin ,
Catriona Mc Daid ,
Kate H. Durée ,
Robert J. O. Davies ,
John R. Stradling ,
Marie E. Westwood  and
Mark J. Sculpher
Helen L. A. Weatherly
Affiliation:
University of York
Susan C. Griffin
Affiliation:
University of York
Catriona Mc Daid
Affiliation:
University of York
Kate H. Durée
Affiliation:
University of York
Robert J. O. Davies
Affiliation:
Oxford Radcliffe Hospital
John R. Stradling
Affiliation:
Oxford Radcliffe Hospital
Marie E. Westwood
Affiliation:
University of York
Mark J. Sculpher
Affiliation:
University of York
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Abstract

Objectives: An important option for the medical treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) is continuous positive airway pressure (CPAP) during sleep. This study reports on the cost-effectiveness of CPAP compared with dental devices and lifestyle advice. The work was commissioned by the NHS HTA Programme to inform the National Institute of Health and Clinical Excellence's (NICE) appraisal of CPAP.

Methods: A Markov model compared the interventions over the expected patient lifetime. The primary measure of cost-effectiveness was the incremental cost per quality-adjusted life-year (QALY) gained. The QALY incorporated the impact of treatments on daytime sleepiness, blood pressure and health-related quality of life (HRQoL).

Results: On average, CPAP was associated with higher costs and QALYs compared with dental devices or lifestyle advice. In the base-case analysis, the incremental cost-effectiveness ratio (ICER) for CPAP compared with dental devices was around £4,000 per QALY (2005–06 prices). The probability that CPAP is more cost-effective than dental devices or lifestyle advice at a threshold value of £20,000 per QALY was 0.78 for men and 0.80 for women. Several sensitivity analyses were undertaken and it was found that the ICER for CPAP consistently fell below £20,000 per QALY gained, apart from in a subgroup with mild disease.

Conclusions: The model suggests that CPAP is cost-effective compared with dental devices and lifestyle advice for adults with moderate or severe symptomatic OSAHS at the cost-effectiveness thresholds used by NICE. This finding is reflected in the NICE guidance.

Keywords

Continuous positive airway pressureObstructive sleep apneaCost-effectiveness
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 1 , January 2009 , pp. 26 - 34
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

1. Anderson, KM, Odell, PM, Wilson, PW, Kannel, WB. Cardiovascular disease risk profiles. Am Heart J. 1990;121 (pt 2):293–298.CrossRefGoogle Scholar
2. Ayas, NT, FitzGerald, JM, Fleetham, JA, et al. Cost-effectiveness of continuous positive airway pressure therapy for moderate to severe obstructive sleep apnea/hypopnea. Arch Intern Med. 2006;166:977–984.CrossRefGoogle ScholarPubMed
3. Barbe, F, Sunyer, J, de la Pena, A, et al. Effect of continuous positive airway pressure on the risk of road accidents in sleep apnea patients. Respiration. 2007;74:44–49.CrossRefGoogle ScholarPubMed
4. Bravo Vergel, Y, Palmer, S, Asseburg, C, et al. Is primary angioplasty cost-effective in the UK? Results of a comprehensive decision analysis. Heart. 2007;93:1238–1243.CrossRefGoogle ScholarPubMed
5. Brazier, J, Roberts, J, Deverill, M. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002;21:271–292.CrossRefGoogle ScholarPubMed
6. Brazier, J, Usherwood, T, Harper, R, Thomas, K. Deriving a preference-based single index from the UK SF-36 Health Survey. J Clin Epidemiol. 1998;51:1115–1128.CrossRefGoogle ScholarPubMed
7. Briggs, A, Claxton, K, Sculpher, M. Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.CrossRefGoogle Scholar
8. Briggs, A, Mihaylova, B, Sculpher, M, et al. The cost-effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA study. Heart. 2007;93:1081–1086.CrossRefGoogle ScholarPubMed
9. Chakravorty, I, Cayton, RM, Szczepura, A. Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome. Eur Respir J. 2002;20:1233–1238.CrossRefGoogle ScholarPubMed
10. Chiang, CL. Introduction to stochastic processes in biostatistics. New York: John Wiley; 1968.Google Scholar
11. Chilcott, J, Clayton, E, Chada, N, et al. Nasal continuous positive airways pressure in the management of sleep apnoea. Leicester: Trent Institute for Health Services Research; 2000.Google Scholar
12. Currie, C, McEwan, P, Peters, J, Patel, TC, Dixon, S. The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository (HODaR): Descriptive analysis from the first 20,000 subjects. Value Health. 2005;8:581–590.CrossRefGoogle ScholarPubMed
13. Curtis, L, Netten, A. Unit costs of health and social care 2006. http://www.pssru.ac.uk/uc/uc2006contents.htm. Accessed 6 June 2007.Google Scholar
14. Dolan, P, Gudex, C, Kind, P, Williams, A. The time trade-off method: Results from a general population study. Health Econ. 1996;5:141–154.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
15. Dennis, MS, Burn, JP, Sandercock, PA, et al. Long-term survival after first-ever stroke: The Oxfordshire Community Stroke. Stroke. 1993;24:796–800.CrossRefGoogle ScholarPubMed
16. Department of Health. NHS reference costs 2005. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4133221. Accessed 31 May 2007.Google Scholar
17. Department of Transport. Highways economic note No.1. 2004. http://www.dft.gov.uk/pgr/roadsafety/ea/highwayseconomicnoteno12004. Accessed 9 May 2007.Google Scholar
18. Drummond, M, Sculpher, M, Torrance, G, O'Brien, BJ, Stoddart, GL. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.CrossRefGoogle Scholar
19. Edwards, MJ, Brickley, MR, Goodey, RD, Shepherd, JP. The cost, effectiveness and cost effectiveness of removal and retention of asymptomatic, disease free third molars. Br Dent J. 1999;187:380–384.CrossRefGoogle ScholarPubMed
20. Fenwick, E, Claxton, K, Sculpher, M. Representing uncertainty: The role of cost-effectiveness acceptability curves. Health Econ. 2001;10:779–789.CrossRefGoogle ScholarPubMed
21. Jenkinson, C, Davies, RJ, Mullins, R, Stradling, JR. Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea. QJM. 2001;94:95–99.CrossRefGoogle ScholarPubMed
22. Jenkinson, C, Stradling, J, Petersen, S. Comparison of three measures of quality of life outcome in the evaluation of continuous positive airways pressure therapy for sleep apnoea. J Sleep Res. 1997;6:199–204.CrossRefGoogle ScholarPubMed
23. Jones, L, Griffin, S, Palmer, S, et al. Clinical effectiveness and cost-effectiveness of clopidogrel and modified-release dipyridamole in the secondary prevention of occlusive vascular events: A systematic review and economic evaluation The cost-effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA study. Health Technol Assess. 2004;8:1–210.CrossRefGoogle Scholar
24. Mar, J, Rueda, JR, Duran-Cantolla, J, et al. The cost-effectiveness of nCPAP treatment in patients with moderate-to-severe obstructive sleep apnoea. Eur Respir J. 2003;21:515–522.CrossRefGoogle ScholarPubMed
25. McArdle, N, Devereux, G, Engleman, HM, Haidarnejad, H. Patterns of continuous positive airways pressure (CPAP) use at the Scottish National Sleep Centre. Thorax. 1997;52 (Suppl 6):S34.Google Scholar
26. Mc Daid, C, Griffin, S, Weatherly, H, et al. Continuous positive airway pressure for the treatment of obstructive sleep apnoea-hypopnoea syndrome: A systematic review and economic analysis. Health Technol Assess. In press.Google Scholar
27. Moyer, CA, Sonnad, SS, Garetz, SL, Helman, JI, Chervin, RD. Quality of life in obstructive sleep apnea: A systematic review of the literature. Sleep Med. 2001;2:477–491.CrossRefGoogle ScholarPubMed
28. , NICE. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Quick Reference Guide. Technology appraisal guidance; no. 139. London: National Institute for Health and Clinical Excellence; 2008.Google Scholar
29. , NICE. Guide to the methods of technology appraisal. Report No.: NO515. London: National Institute for Health and Clinical Excellence; 2004.Google Scholar
30. Pepperell, JC, Ramdassingh-Dow, S, Crosthwaite, N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomised parallel trial. Lancet. 2002;359:204–210.CrossRefGoogle ScholarPubMed
31. Resmed. Cost-effectiveness and cost-utility of using continuous positive airways pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the UK. Resmed submission for CPAP technology appraisal. Abingdon: ResMed (UK); 2007.Google Scholar
32. Rosengren, A, Wilhelmsen, L, Hagman, M, Wedel, H. Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: A 16-year follow-up of the Primary Prevention Study, Göteborg, Sweden. J Intern Med. 1998;244:495–505.CrossRefGoogle Scholar
33. Sassani, A, Findley, LJ, Kryger, M, et al. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep. 2004;27:453–458.CrossRefGoogle ScholarPubMed
34. Smith, I, Lasserson, TJ, Wright, J. Drug therapy for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006;19:CD003002.Google Scholar
35. Sullivan, PW, Ghushchyan, V. Preference-based EQ-5D index scores for chronic conditions in the United States. Med Decis Making. 2006;26:410–420.CrossRefGoogle ScholarPubMed
36. Sundaram, S, Bridgman, SA, Lim, J, Lasserson, TJ. Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev. 2005;19:CD001004.Google Scholar
37. Tousignant, P, Cosio, MG, Levy, RD, Groome, PA. Quality adjusted life years added by treatment of obstructive sleep apnea. Sleep. 1994;17:52–60.Google ScholarPubMed
38. West, SD, Nicoll, DJ, Wallace, TM, Matthews, DR, Stradling, JR. The effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes [unpublished observation]. 2007.CrossRefGoogle Scholar
39. van Hout, BA, Al, MJ, Gordon, GS, et al. Cost, effects and cost-effectiveness-ratios alongside a clinical trial. Health Econ. 1994;3:309–319.CrossRefGoogle ScholarPubMed
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