COST-EFFECTIVENESS OF TREATMENTS FOR MILD-TO-MODERATE OBSTRUCTIVE SLEEP APNEA IN FRANCE. (9th March 2016)

• Record Type: Journal Article
• Authors: Poullié, Anne-Isabelle; Cognet, Magali; Gauthier, Aline; Clementz, Marine; Druais, Sylvain; Späth, Hans-Martin; Perrier, Lionel; Scemama, Oliver; Pichon, Catherine Rumeau; Harousseau, Jean-Luc
• Is Part Of: International journal of technology assessment in health care. Volume 32:Number 1/2(2016)
• Page Start: 37
• Page End: 45
• Publication Date: 2016-03-09
• Subjects: Continuous positive airway pressure, -- Dental devices, -- Obstructive sleep apnea, -- Cost-effectiveness analysis; Medical technology -- Periodicals; Technology assessment -- Periodicals; 610.28
• DOI: 10.1017/S0266462316000088
• Languages: English
• ISSNs: 0266-4623

Abstract

Abstract : Objectives: Untreated obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with excessive daytime sleepiness, increased risk of cardiovascular (CV) disease, and road traffic accidents (RTAs), which impact survival and health-related quality of life. This study, funded by the French National Authority for Health (HAS), aimed to assess the cost-effectiveness of different treatments (i.e., continuous positive airway pressure [CPAP], dental devices, lifestyle advice, and no treatment) in patients with mild-to-moderate OSAHS in France. Methods: A Markov model was developed to simulate the progression of two cohorts, stratified by CV risk, over a lifetime horizon. Daytime sleepiness and RTAs were taken into account for all patients while CV events were only considered for patients with high CV risk. Results: For patients with low CV risk, incremental cost-effectiveness ratio (ICER) of dental devices versus no treatment varied between 32, 976 EUR (moderate OSAHS) and 45, 579 EUR (mild OSAHS) per quality-adjusted life-year (QALY), and CPAP versus dental devices, above 256, 000 EUR/QALY. For patients with high CV risk, CPAP was associated with a gain of 0.62 QALY compared with no treatment, resulting in an ICER of 10, 128 EUR/QALY. Conclusion: The analysis suggests that it is efficient to treat all OSAHS patients with high CV risk with CPAP and that dental devices are more efficient than CPAP for mild-to-moderate OSAHS with low CV risk. However, out-of-pocket costs are currently much higher for dental devices than for CPAP (i.e., 3, 326 EUR versus 2, 430 EUR) as orthodontic treatment is mainly non-refundable in France.