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Original article
A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial
  1. Valentina Isetta1,2,3,
  2. Miguel A Negrín4,
  3. Carmen Monasterio3,5,
  4. Juan F Masa3,6,
  5. Nuria Feu7,
  6. Ainhoa Álvarez8,
  7. Francisco Campos-Rodriguez9,
  8. Concepción Ruiz10,
  9. Jorge Abad3,11,
  10. Francisco J Vázquez-Polo4,
  11. Ramon Farré1,2,3,
  12. Marina Galdeano12,
  13. Patricia Lloberes3,13,
  14. Cristina Embid3,10,
  15. Mónica de la Peña3,14,
  16. Javier Puertas15,16,
  17. Mireia Dalmases3,10,
  18. Neus Salord3,5,
  19. Jaime Corral3,6,
  20. Bernabé Jurado7,
  21. Carmen León10,
  22. Carlos Egea8,
  23. Aida Muñoz11,
  24. Olga Parra3,12,
  25. Roser Cambrodi13,
  26. María Martel-Escobar4,
  27. Meritxell Arqué14,
  28. Josep M Montserrat3,10,
  29. the SPANISH SLEEP NETWORK
    1. 1Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
    2. 2Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
    3. 3Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
    4. 4Departamento de Métodos Cuantitativos y TiDES Institute, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Islas Canarias, Spain
    5. 5Unidad del Sueño, Servicio de Neumología, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
    6. 6Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
    7. 7Unidad del Sueño, Hospital Universitario Reina Sofía, Universidad de Córdoba, IMIBIC, Córdoba, Spain
    8. 8Unidad Funcional de Sueño, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
    9. 9Servicio de Neumología, Hospital Universitario de Valme, Sevilla, Spain
    10. 10Servicio de Neumología, Unidad del Sueño, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
    11. 11Servicio de Neumología, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
    12. 12Servicio de Neumología, Hospital Universitario Sagrat Cor, Universidad de Barcelona, Barcelona, Spain
    13. 13Servicio de Neumología, Unidad del Sueño, Hospital Universitario Vall d´Hebron, Barcelona, Spain
    14. 14Servicio de Neumología, Hospital Universitario Son Espases, IdisPa, Palma de Mallorca, Spain
    15. 15Departamento de Neurofisiología Clínica y Unidad del Sueño, Hospital Universitario La Ribera, Alzira, Valencia, Spain
    16. 16Departamento de Fisiología, Universidad de Valencia, Valencia, Spain
    1. Correspondence to Dr Valentina Isetta, Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Casanova 143, Barcelona, 08036, Spain; valentina.isetta{at}ub.edu

    Abstract

    Background Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management.

    Aim To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up.

    Methods A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed.

    Results We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant.

    Conclusions A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs).

    Trial register number NCT01716676.

    • Sleep apnoea

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