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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.

 Fuente: Thorax . 2020 Jun;75(6):459-467

Editorial: BMJ Publishing Group

 Año de publicación: 2020

Nº de páginas: 9

Tipo de publicación: Artículo de Revista

 DOI: 10.1136/thoraxjnl-2019-213622

ISSN: 0040-6376,1468-3296

Url de la publicación: https://doi.org/10.1136/thoraxjnl-2019-213622

Autoría

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

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, FERRÁN

CORRAL PEÑAFIEL, JAIME

SPANISH SLEEP NETWORK