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Cost-effectiveness of using continuous positive airways pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the uk
  1. Julian F Guest (julian.guest{at}catalyst-health.co.uk)
  1. Catalyst Health Economics Consultants, United Kingdom
    1. Marianne T Helter (info{at}catalyst-health.co.uk)
    1. Catalyst Health Economics Consultants, United Kingdom
      1. Antonella Morga (info{at}catalyst-health.co.uk)
      1. Catalyst Health Economics Consultants, United Kingdom
        1. John R Stradling (john.stradling{at}orh.nhs.uk)
        1. Churchill Hospital, United Kingdom

          Abstract

          Objective: To estimate the cost-effectiveness of using continuous positive airway pressure (CPAP) in the management of patients suffering from severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS), compared to 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 to 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 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 to 72% of CPAP-treated patients. Untreated patients are expected to cost the NHS £10,645 (95% CI: £7,988; £14,098) per patient over 14 years compared to £9,672 (95% CI: £8,057; £12,860) per CPAP-treated patients. Treatment with CPAP for a period of one year was found not to be a cost-effective option since the cost per QALY gained is expected to be >£20,000, but after two 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 (i.e. more effective than no treatment for less cost).

          Conclusion: Within the limitations of our model, CPAP was found to be clinically more effective than no treatment and the cost-effective strategy, from the perspective of the UK's NHS, after a minimum of 2 years' treatment.

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