Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea.

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.

• Authors: Juan F Masa, Babak Mokhlesi, Iván Benítez, Francisco Javier Gómez de Terreros Caro, M-Ángeles Sánchez-Quiroga, Auxiliadora Romero, Candela Caballero, Maria Luz Alonso-Álvarez, Estrella Ordax-Carbajo, Teresa Gómez-García, Mónica González, Soledad López-Martín, Jose M Marin, Sergi Martí, Trinidad Díaz-Cambriles, Eusebi Chiner, Carlos Egea, Javier Barca, Francisco-José Vázquez-Polo, Miguel Angel Negrín, María Martel-Escobar, Ferran Barbé, Jaime Corral-Peñafiel, Spanish Sleep Network
• Journal: Thorax (Thorax) Vol. 75 Issue 6 Pg. 459-467 (06 2020) ISSN: 1468-3296 [Electronic] England
• PMID: 32217780 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Aged
• Bayes Theorem
• Continuous Positive Airway Pressure (economics)
• Cost-Benefit Analysis
• Female
• Humans
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Noninvasive Ventilation
• Obesity Hypoventilation Syndrome (physiopathology, therapy)
• Polysomnography
• Severity of Illness Index
• Spain
• Spirometry