Cost-effectiveness of using continuous positive airway pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the UK

• Published in: Thorax Vol. 63; no. 10; pp. 860 - 865
• Main Authors: Guest, J F, Helter, M T, Morga, A, Stradling, J R
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.10.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Accidents, Traffic; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular Diseases - etiology; Continuous positive airway pressure; Continuous Positive Airway Pressure - economics; Cost analysis; Cost-Benefit Analysis; Epidemiology; Fatalities; Health Care Costs; Heart attacks; Humans; Hypertension; Medical sciences; Patient Compliance; Pneumology; Quality-Adjusted Life Years; Respiratory system : syndromes and miscellaneous diseases; Sleep apnea; Sleep Apnea, Obstructive - economics; Sleep Apnea, Obstructive - therapy; Stroke; Traffic; United Kingdom; Europe; United Kingdom > UK; Nervous system diseases; Sleep apnea syndrome; Respiratory disease; Continuous; Artificial ventilation; Respiratory tract; Treatment; Positive pressure; Health economy; Anesthesia; Circulatory system; Cardiology; Severe; Mechanical ventilation; Cost efficiency analysis
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.2007.086454

Objective:A study was undertaken to estimate the cost-effectiveness of using continuous positive airway pressure (CPAP) in the management of patients with severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS) compared with no treatment from the perspective of the UK’s National Health Service (NHS).Methods:A Markov model was constructed to assess the cost-effectiveness of CPAP compared with no treatment. The model depicted the management of a 55-year-old patient with severe OSAHS as defined by an apnoea-hypopnoea index (AHI) >30 and daytime sleepiness (Epworth Sleepiness Scale score ⩾12). The model spans a period of 14 years.Results:According to the model, 57% of untreated patients are expected to be alive at the end of 14 years compared with 72% of patients treated with CPAP. Untreated patients are expected to cost the NHS £10 645 (95% CI £7988 to £14 098) per patient over 14 years compared with £9672 (95% CI £8057 to £12 860) per CPAP-treated patient. Treatment with CPAP for a period of 1 year was found not to be a cost-effective option since the cost per quality-adjusted life year (QALY) gained is expected to be >£20 000, but after 2 years of treatment the cost per QALY gained is expected to be £10 000 or less and, after 13 years of treatment, CPAP becomes a dominant treatment (ie, more effective than no treatment for less cost).Conclusion:Within the limitations of the model, CPAP was found to be clinically more effective than no treatment and, from the perspective of the UK’s NHS, a cost-effective strategy after a minimum of 2 years of treatment.