Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea. Issue 6 (26th March 2020)

• Record Type: Journal Article
• Authors: Masa, Juan F; Mokhlesi, Babak; Benítez, Iván; Gómez de Terreros Caro, Francisco Javier; Sánchez-Quiroga, M-Ángeles; Romero, Auxiliadora; Caballero, Candela; Alonso-Álvarez, Maria Luz; Ordax-Carbajo, Estrella; Gómez-García, Teresa; González, Mónica; López-Martín, Soledad; Marin, Jose M; Martí, Sergi; Díaz-Cambriles, Trinidad; Chiner, Eusebi; Egea, Carlos; Barca, Javier; Vázquez-Polo, Francisco-José; Negrín, Miguel Angel; Martel-Escobar, María; Barbé, Ferran; Corral-Peñafiel, Jaime
• Other Names: author non-byline.; Masa Juan F author non-byline.; Mokhlesi Babak author non-byline.; Benítez Iván author non-byline.; Gomez de Terreros Francisco Javier author non-byline.; Sánchez-Quiroga Maria Ángeles author non-byline.; Romero Auxiliadora author non-byline.; Caballero-Eraso Estrella Ordax Candela author non-byline.; Alonso-Álvarez Maria Luz author non-byline.; Troncoso Maria F author non-byline.; González Mónica author non-byline.; López-Martín Soledad author non-byline.; Marin José M author non-byline.; Martí Sergi author non-byline.; Díaz-Cambriles Trinidad author non-byline.; Chiner Eusebi author non-byline.; Egea Carlos author non-byline.; Vázquez-Polo Francisco-José author non-byline.; Negrín Miguel A author non-byline.; Martel-Escobar María author non-byline.; Barbe Ferran author non-byline.; Corral Jaime author non-byline.; Utrabo Isabel author non-byline.; Gonzalez-Mangado Nicolas author non-byline.; F Troncoso María author non-byline.; Martinez-Martinez M-Ángeles author non-byline.; Castillejo Elena Ojeda author non-byline.; López-Padilla Daniel author non-byline.; Carrizo Santiago author non-byline.; Gallego Begoña author non-byline.; Pallero Mercedes author non-byline.; Romero Odile author non-byline.; Ramon Maria A author non-byline.; Arias Eva author non-byline.; Méndez Jesús Muñoz author non-byline.; Cristina Senent author non-byline.; Sancho-Chust Jose N author non-byline.; Navarro-Soriano Nieves Belén author non-byline.; Cabrero Jaime Marcos author non-byline.; Sanchez Gomez Jesus Fernando author non-byline.; Golpe Rafael author non-byline.; Gomez Mendieta M Antonia author non-byline.; Gomez Silvia author non-byline.; Bengoa Mónica author non-byline.;
• Is Part Of: Thorax. Volume 75:Issue 6(2020)
• Page Start: 459
• Page End: 467
• Publication Date: 2020-03-26
• Subjects: sleep apnoea -- non invasive ventilation; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2019-213622
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Obesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities. Objectives: We performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure. Methods: Hospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed. Results: In total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups. Conclusion: CPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA. Trial registration number: NCT01405976