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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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