• sleep apnoea
• cost effectiveness
• motor vehicle collisions
• continuous positive airway pressure (CPAP)

The paper by George¹ showing a decrease in road accidents with continuous positive airway pressure (CPAP) therapy in the July issue of Thorax was accompanied by an editorial quantifying the cost savings based on USA accident costs.² As most sleep services in the UK are having difficulty funding CPAP treatment, there is a need to put the cost benefits into a UK context, which we have done using George's data.

According to the UK Department of Transport official figures for 1999,³ fatal accidents cost £1 253 140 each, accidents with personal injury cost £49 800, and property damage only accidents cost £1300 each. George's study was performed in Ontario and examined accidents involving either personal injury, more than $500 of damage, or a traffic violation. In 1999 Ontario had 221 962 such accidents, of which 763 were fatal, 55 764 were associated with personal injury, and 165 435 with property damage only.⁴

Thus, using George's data,¹ treating 500 patients with CPAP for 5 years would prevent 1.03 fatal accidents at a saving of £1.292 million, 75.4 personal injury accidents at a saving of £3.753 million, and 224 property damage accidents at a cost saving of £0.290 million. The total accident related cost saving would therefore be £5.335 million compared with a treatment cost of £0.4 million (500 CPAP units at £300 and £100 per annum for consumables and follow up costs), giving a saving of £4.935 million at a 12.3-fold return on pounds spent.

These savings do not take into account those from the marked and now well documented improvements in work performance, quality of life,⁵ and blood pressure,⁶ and decrease in hospitalisation costs⁷ resulting from CPAP treatment. It is time health service planners recognised these benefits and this cost efficacy, and that sleep apnoea services were accorded the appropriate priority in the health budget.