SLEEP-DISORDERED BREATHING

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

J F Guest^1,2, M T Helter¹, A Morga¹, J R Stradling³

¹ Catalyst Health Economics Consultants, Northwood, Middlesex, UK
² Postgraduate Medical School, University of Surrey, Guildford, Surrey, UK
³ Respiratory Sleep Unit, Churchill Hospital, Oxford, UK

Professor J F Guest, Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex HA6 1BN, UK; julian.guest{at}catalyst-health.co.uk

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.

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