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Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome

¹ Dept of Thoracic Medicine, Watford General Hospital, Watford, ² Dept of Respiratory Physiology, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham and ³ Centre for Health Services Studies, Warwick Business School, University of Warwick, Coventry, UK

CORRESPONDENCE: I. Chakravorty, Dept of Thoracic Medicine, Watford General Hospital, Vicarage Road, Watford, UK. Fax: 44 07069950024. E-mail: indranil@altavista.net

Keywords: european quality of life questionnaire, quality-adjusted life years utility, sleep apnoea, standard gamble

Received: August 23, 2001
Accepted June 7, 2002

Formulating a rational health policy necessitates the ability to compare between different healthcare interventions and disease scenarios. Continuous positive airway pressure (CPAP) therapy with a conservative lifestyle strategy in sleep apnoea/hypopnoea syndrome (SAHS) was evaluated using health utility and quality-adjusted life years (QALYs) as outcome measures.

A total 71 SAHS (apnoea/hypopnoea index 15 h^–1) patients completed a randomised, parallel group study over 3 months using utilities derived by the standard gamble approach (U_sg) and European quality of life questionnaire (Euroqol) (U_eq).

The severely impaired health status at baseline improved by 23% (U_sg 0.32 to 0.55) adding 8 QALYs in the CPAP group, compared to a 4% improvement with 4.7 QALYs added in the lifestyle group (U_sg 0.31 to 0.35). The U_eq showed a marginal change with CPAP (0.73 to 0.77) but did not demonstrate any improvement with lifestyle intervention.

The health status impairment in sleep apnoea/hypopnoea syndrome patients is markedly improved by continuous positive airway pressure compared to a modest improvement with conservative lifestyle strategies using the standard gamble utility, which may be incorporated in effectiveness and economic analyses. The European quality of life questionnaire did not reflect a similar degree of impact and is probably not useful in this population.

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